The Role of Compliance in Government Enforcement

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As recent developments in corporate enforcement indicate, the United States Department of Justice (DOJ) continues to emphasize transparency, cooperation, and the importance of a strong compliance program. Enforcement trends indicate a continued focus on fraud in the healthcare industry. In fact, of the $3 billion in False Claims Act (FCA) recoveries in the 2019 fiscal year, $2.6 billion related to matters involving healthcare. (DOJ’s strong emphasis on healthcare fraud is not unique to the current administration. Healthcare fraud was also a central focus of the Obama administration. For example, in 2009, a joint DOJ and Department of Health & Human Services task force known as the Health Care Fraud Prevention and Enforcement Action Team was created.) Further, the COVID-19 stimulus programs have paved the way for new types of healthcare fraud. This article explores recent governmental enforcement activity, including recent guidance documents, pronouncements, and memoranda. It discusses a powerful enforcement tool used by the DOJ in corporate enforcement - independent compliance monitors. Lastly, this article explores the evolution of corporate integrity agreements (CIAs), which provide a perspective on the Department of Health & Human Services Office of Inspector General’s priorities for healthcare compliance program structure and content.

Originally published in Compliance Today - November 2020.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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