What the OIG and DOJ’s Latest Fraud Alert Means to Your Organization

If you’re unfamiliar with the Office of Inspector General (OIG) and Department of Justice’s (DOJ) Special Fraud Alerts, you’d be forgiven. After all, in the last 26 years, they have only published a total of 11 Special Fraud Alerts. And prior to their most recent release on November 16 of 2020, they hadn’t issued an alert since June of 2014.

That 2014 alert focused on compensation “paid by laboratories to referring physicians and physician group practices (collectively, physicians) for blood specimen collection, processing, and packaging, and for submitting patient data to a registry or database.” Fundamentally, this alert was focused on the anti-kickback statute, which was created to protect patients from inappropriate medical referrals by physicians and other healthcare professionals who may be influenced by illegal financial incentives. And since this alert was originally published, the OIG and DOJ have never wavered on their commitment to pursuing and fining organizations and individuals found to be in violation.

Based on history, and the frequency with which the federal government issues these alerts, it’s a good practice to pay close attention when the OIG does publish an update, and conduct your own due diligence to ensure your organization and its employees remain compliant.

This November’s Special Fraud Alert served to highlight “the fraud and abuse risks associated with the offer, payment, solicitation, or receipt of remuneration relating to speaker programs by pharmaceutical and medical device companies.” The OIG defined speaker programs as “company-sponsored events at which a physician or other healthcare professional makes a speech or presentation to others about a drug or device product or a disease state on behalf of the company.”

Speaking programs are big business, as evidenced by this one piece of data: In the last three years, drug and device companies have reported paying nearly $2 billion for speaker-related services.

As part of the special fraud alert, the OIG and DOJ stated that they have investigated and resolved numerous fraud cases involving allegations that remuneration offered and paid in connection with speaker programs violated the anti-kickback statute. In one case, a drug and/or device company placed conditions around speaker remuneration on sales targets (e.g., they required speakers to write a minimum number of prescriptions in order to receive their compensation), while another specifically targeted high-prescribing healthcare professionals to be speakers, then rewarding them with lucrative speaker deals, some of whom received hundreds of thousands of dollars in speaking fees.

To further highlight the compliance risks healthcare organizations face, join our upcoming webinar on Wednesday, February 3 at 1 PM ET, titled “Special Fraud Alerts: What You Need to Know,” where we’ll focus on the most recent Special Fraud Alert regarding Speaker Programs, and I'll discuss:

• Recent Settlement that Prompted the Special Fraud Alert
• Inherent Threats to the Pharmaceutical and Medical Device Industries
• Potential Risks to Your Physicians Who Speak at These Events

Oh, and did I mention you’ll get a free HCCA CEU for attending the live presentation? Hope to see you there!