When it comes to compliance, prosecutors want to see more than paper

DOJ

The perceived strength of a company’s compliance program carries tremendous weight during a fraud investigation, particularly as prosecutors consider whether to pursue criminal or civil charges, according to RevCycle Intelligence.

Federal prosecutors are interested in not just how a fraud scheme took place, but why it was allowed to unfold, Gejaa Gobena, a partner at Hogan Lovells and former chief of the healthcare fraud unit at the Justice Department's criminal division, told the online publication. Federal prosecutors are placing more weight on the organization's compliance program to determine whether the appropriate compliance measures were in place, and whether the plan includes a compliance officer along with support to provide effective oversight.

Paper compliance is no longer sufficient, he added. Prosecutors consider the effectiveness of each compliance program when deciding whether to bring civil or criminal charges and during the settlement process. 

“Real compliance programs that have real teeth to them can be circumvented if there are people who are going to act unscrupulously,” Gobena told RevCycle Intellegence. “But if it looks like the company is trying with a real compliance program, that'll certainly factor into whether a prosecutor decides if criminal or civil charges are more appropriate.”

Corporate compliance, along with self-disclosures, have been key features of federal fraud investigations since the Office of Inspector General released guidance in 2014 aimed at helping governing boards strengthen compliance.

Earlier this month, Gobena told FierceHealthPayer: Antifraud how data revolutionized fraud prosecutions, and discussed the impact of large scale fraud busts.

- read the RevCycle Intelligence article