At the end of 2017, the U.S. Department of Justice (DOJ) issued its annual recovery statistics – more than $3.7 billion in total recoveries. Of the $3.7 billion recovered, $2.4 billion were associated with settlements and judgements from the healthcare industry. With another record year on the books, healthcare organizations should expect healthcare fraud to be a key area of focus in 2018.
So what can your organization do to mitigate risk?
Know your data. Most hospitals and health systems have extensive amounts of data available to them with the increase in electronic data capture. How is your organization using this data to identify risk? The government is increasingly using data to analyze an organization’s billing and claims submission practices to prioritize outliers/targets. If your organization is not already – you should be. Using the most recent MedPAR data available, our clinical team can conduct a data analysis to assess potential revenue and compliance opportunities as compared to peer hospitals in your state, region or nationally. We can look across service lines and help pinpoint potential areas of opportunity.
Know the strength of your compliance program. You may have a robust compliance program on paper, but have you tested the effectiveness/application of your standards? With the issuance of the DOJ’s Guidance, “Evaluation of Corporate Compliance Programs” as used in criminal investigations, in conjunction with longstanding Health and Human Services guidance, hospitals and health systems have an outline for an effective program. Our team of seasoned compliance professionals can work with your organization to identify areas of strength, opportunity and remediation plans to ensure your compliance program is effective and can stand up in the wake of a government investigation.
For more information on our data analytics and compliance program services, contact us at firstname.lastname@example.org.