A report recently released shows that federal health care fraud prosecutions so far this year are on pace to rise 85% over last year, according to an article appearing this week in USA Today.  This drastic increase does not come as a shock to many health care law insiders.  The federal government has made clear its objectives to ramp up anti-fraud efforts in the health care sector and to recover payments made for fraudulent claims billed to federal health care programs including Medicare and Medicaid.

According to the article, not only have health care fraud prosecutions sharply increased, but also convictions.  Government officials confirm these findings and hope to continue on this path.  In 2010, the government recovered a record $4 billion from health care fraud cases.  The government has added two new health care fraud teams to its arsenal this year, and it continues to utilize innovative technology to uncover instances of fraud.  These anti-fraud initiatives are made possible in part by the Affordable Care Act, which provides additional funding to target health care fraud and to invest in sophisticated new tools and technology to uncover fraud.

What Does This Mean for Health Care Providers?

As the government continues to increase its anti-fraud efforts, health care providers must ensure their own compliance with federal regulations and guidelines.  The federal government has explicitly recommended the implementation of a comprehensive health care compliance program to help avoid fraudulent billing to Medicare, Medicaid and other government health care programs.  A health care compliance program helps to identify areas of risk with respect to coding, documentation and fraud and abuse laws.  Further, under the Affordable Care Act, federal law will soon require health care providers to implement a compliance program as a condition of participation under Medicare and Medicaid.

Regulatory compliance for health care providers is very complex, so it is highly recommended to consult an experienced health law attorney for assistance with the design and implementation of a compliance program.  At The Martin Law Firm, we assist our broad health care client base in the design, development, implementation and review of health care compliance programs and policies.  We assist clients with billing, coding and documentation guidelines; fraud and abuse laws, including Stark, Anti-Kickback and the False Claims Act; education and training polices; and investigation and corrective action plans.  Preventing legal problems before they begin is always a sound defense strategy.  Contact The Martin Law Firm today to discuss your health care compliance and reimbursement needs.