Compliance Perspectives

By Adam Turteltaub There’s a lot new going on in healthcare enforcement, and, at the same, there’s a lot that hasn’t changed, reports Greg Demske (LinkedIn), partner at Goodwin Proctor and, formerly, Chief Counsel to the Inspector General at HHS. While the US Department of Justice has changed its priorities in areas such as anticorruption, if you look at what they and the Office of Inspector General (OIG) at Health and Human Services have been doing, he observes, the long-time bipartisan effort to stop fraud in healthcare is continuing. Yet, there are some significant changes.  At CMS a major shift has occurred when it comes to Medicare Advantage.  In the past there were audits of fifty plans a year, but now the goal is to audit all six hundred or so annually.  Backing that up is an expansion in the number of coders from 40 to 2000.  This has huge implications both for the plans and providers. Meantime the Department of Justice and HHS have created a False Claims Act Working group to further their efforts