Investigators increase focus on kickbacks
Cases heading to new forum
To drive home how serious they take the new compliance guidelines being developed by the Office of the Inspector (OIG), government compliance cops are launching a campaign to pinch providers who appear to be on the wrong side of federal referral and anti-kickback rules.
"We definitely plan to increased enforcement of the anti-kickback statute," reports Kevin McAnaney, who runs the OIG’s industry guidance programs. "My advice is noncompliance with the new physician guidelines would be considered reckless," warns Lewis Morris, the OIG’s deputy associate general counsel.
Referring to a study in the April 12 Journal of the American Medical Association that concluded 39% of physicians have lied to secure insurance coverage for a patient, Leslie Caldwell, an assistant U.S. attorney in the Justice Department’s northern California district, predicted, "We may go after somebody to send a message."
Another sensitive area for physicians could be charges of kickbacks relating to office rental agreements covered under the OIG’s recent safe harbor guidelines.
As part of this action, the OIG will bring the kickback cases it comes across to administrative law judges rather than run them through the regular court system. The reasoning behind this tactic is that the government’s burden of proof is lighter when trying a case before an administrative law judge, making it easier to win the case.
When it comes to levying judgments, administrative law judges can bar providers from participating in federal heath programs plus hit them with civil fines of up to $50,000 per violation.
Other areas where federal investigators plan to focus attention are nursing homes, long-term-care facilities, and pharmaceutical benefit management agreements. There also will be more audits of managed care companies, with investigators looking for Medicare HMOs that cherry-pick healthy patients for membership and avoid signing up sicker seniors.
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