How many compliance related crimes have you or your colleagues or employees committed today, whether purposefully or, completely inadvertently?
A friend, a former federal prosecutor, recently told me about a book called Three Felonies a Day. The book addresses the fact that, due to the burgeoning number of criminal laws and, even more concerning, regulations imposing criminal penalties including imprisonment, almost everyone unknowingly commits a number of acts each day that could be charged as federal crimes by overzealous prosecutors.
Among the top hits for many medical groups are billing related crimes. The wrong code, the overstated anesthesia time, the unknowing Stark Law violation, can all result in criminal liability charged under multiple federal laws such as health care fraud, mail fraud, and wire fraud.
Also ever popular are violations of the federal Anti-Kickback Statute, a criminal law making it illegal to offer, solicit, pay, or receive any remuneration for the referral of federal health care program patients. What, you didn’t realize that health services for Peace Corps volunteers are one of the covered programs? Oops. Felony time.
The sheer magnitude of the punishment, let alone being tossed out of further participation in federal health care programs, means that medical groups must take prophylactic steps to prevent, detect, and remedy compliance law violations. As in now. Before you get caught.
For example, every physician group’s (or health care entity’s) billing and coding operations, whether in-house or outsourced, should be audited on at least an annual basis, if not more often. And, every group must have an active compliance program, not just a “policy” or a “plan” kept in a three-ring binder designed to gather dust.
Let’s all go on a felony diet, starting today.
It doesn’t require much will power. You can get all the help you need.
Comment or contact me if you’d like to discuss this post.
Mark F. Weiss