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Is your company being targeted in health care fraud probes?

A recent in-depth media profile calls it "a target-rich environment for investigation and prosecution." That same report also stresses that federal criminal enforcement over it "stands poised to become increasingly muscular and robust."

The subject matter comprising "it" in the above piece is health care fraud. That realm is unquestionably a top-tier focus of national regulators and prosecutors presently.

Proof of that is ample. There is a year-to-year spike in federal funding earmarked toward health care fraud investigations across the country. And that is coupled with progressively more indictments, prosecutions and criminal convictions yielding draconian penalties -- including lengthy prison terms -- for defendants. Reportedly, $770 million or more could be allocated to anti-fraud efforts during the current fiscal year.

The team of commentators contributing to the above-cited report -- all former federal prosecutors -- stresses that health care companies of every size and type need to be closely aware that they are being closely watched by federal task forces looking for signs of fraud. Principals in those entities should know that regulators are especially focused on select "red flags" in their probes. Those centrally include things like these:

  • Anything notable that emerges from a close look at opioid makers, prescribers and distributors
  • Billing oddities relating to home health care
  • Anomalies that pop up relevant to coding
  • Evidence of unlawful patient referrals and kickbacks

Given that health care fraud scrutiny has grown so intense, it certainly behooves every health care company to pay attention to areas where regulators are particularly focused and to take actions geared toward lawful compliance and the mitigation of risk.

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