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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