Health Care Providers Caught in the Crossfire: Corporate Compliance Programs are Now a Necessity

Abstract

Recent settlements demonstrate that "Corporate Compliance Programs" can reduce providers' criminal sanctions and monetary fines by as much as 95%. With the passing of the Health Insurance Portability and Accountability Act (HIPPA) in August 1996, health care providers have realized that all providers, not just those motivated to commit fraud, need to implement Corporate Compliance Programs in order to be prepared for the escalating war against federal health care fraud. This legislation contains fraud and abuse provisions including:

1) A coordinated fraud and abuse program;
2) A fraud and abuse control account;
3) The expansion of the Medicare and Medicaid anti-kickback statute to other federal health care programs;
4) The creation of an exception to the anti-kickback statute for risk-sharing arrangements;
5) An increase in civil money penalties;
6) A tightening of the intent standard for the imposition of civil
money penalties;
7) The creation of a health care fraud criminal sanction;
8) The expansion of sanctions applicable to health care fraud; and
9) The establishment of guidance concerning the application of health care fraud and abuse sanctions, including the mandatory issuance of advisory opinions.

There are many lessons to be learned when implementing a Corporate Compliance Program.