Federal officials emphasize compliance, outline shifting areas of fraud

Compliance programs will play a key role in the Office of Inspector General's (OIG) new exclusion guidelines, and federal prosecutors may be slightly shifting their geographical fraud targets, government officials told attendees at the Health Care Compliance Association's Compliance Institute last week.

Daniel Levinson, inspector general for the Department of Health and Human Services, emphasized the importance of compliance programs in a RACmonitor podcast, indicating that federal investigators expect to see "sophisticated" programs that can self-report misconduct to authorities. He said compliance programs would be factored into the OIG's updated exclusion guidance released by the agency last week.  

"It's important that people understand that having a good, effective compliance program [that] is considered state-of-the-art is expected," he said, adding that providers don't get bonus points for simply having a plan, but must establish a program robust enough to catch misconduct.

Levinson also pointed to hospice overpayments and opioid overprescribing under Medicare Part D as two areas of healthcare that have become particularly susceptible to fraud.

Another top government official, Assistant Attorney General Leslie Caldwell, told conference attendees that that the DOJ is incorporating real-time data into fraud prosecutions, according to Bloomberg BNA. She added that the agency is currently reviewing the Medicare Fraud Strike Force program to see if other cities could benefit from the coordinated approach.

To learn more:
- listen to the RACmonitor podcast
- here's the Bloomberg BNA article