Healthcare and hospital leaders must understand the False Claims Act (FCA), Stark Law and Anti-Kickback Statute (AKS) in order to protect their organizations and themselves from lawsuits and other litigation, according to an article in Becker's Hospital Review.
Lawsuits are evolving--from FCA lawsuits filed when healthcare organizations or hospitals billed the government for services they didn't actually perform, or miscoded the service and were overcompensated--to lawsuits filed under Stark and AKS violations, which now rise to the level of an FCA case, said Scott Becker, an attorney with McGuireWoods, at the McGuireWoods Healthcare Litigation Conference this week, Becker's reported.
Organizations increasingly self-report possible Stark, AKS and FCA violations, as opposed to waiting for a whistleblower to bring the issue forward, because the latter cannot serve as the original source of the material, which is required under the FCA, according to Becker's.
"Self-disclosures are unpredictable, and hospitals do not know what the outcome is going to be when they take their self-disclosures to the government," said Becker.
Hospitals should strongly consider settling out of court where possible, even if there was no wrongdoing on their part, because the exposure is so high if they don't. Top law firms specializing in false claims law often represent whistle-blowers, leaving hospitals at risk to pay large sums of monetary damages as well as damage to their reputation, Becker said.
Hospitals must constantly work on compliance planning, with some sort of annual update or review to examine individual physician contracts, and keep on top of audits to prevent lawsuit risks. "Hospitals need to conduct constant billing and coding audits as part of an ongoing compliance plan, and senior leadership needs to be involved," Becker said.
Above all hospital leaders must acknowledge and address all potential FCA issues employees bring forward, and follow through to investigate the potential violation--no matter how big or small, according to the article.
Self-reporting potential fraud isn't necessarily the best option, Forbes columnist Jonathan Sack wrote, saying current protocols for self-disclosure in healthcare "often fall short of expectations," FierceHealthcare previously reported.
To learn more:
- here's the article