Health Care Fraud Outlook for 2016

The article was highlighted in the Health Care Fraud Report.

More Stark/False Claims Act cases

Ms. Baumann noted that the health care industry should expect an uptick in the number of False Claims Act cases being filed, with a focus on allegations involving the Stark Law. “There have been a number of extremely large Stark Law-related settlements recently, but there are few ‘bright lines’ or other guidance to help providers know how to comply in the face of complex, and often ambiguous, legal requirements.”
 
While the new Stark regulations in the 2016 Medicare physician payment rule are helpful, there’s little published case law on several issues that have arisen in recent Stark cases. According to Ms. Baumann, this has increased the risk for providers and “created a potential gold mine for whistleblowers and a continuing nightmare for providers who are trying to do the right thing.”

Enforcement Directed Against Individuals

Another critical issue to watch in 2016 is the federal prosecution of individuals for health care fraud. Ms. Baumann told Bloomberg BNA that the industry is extremely concerned about the possibility of more civil and criminal enforcement against individuals.

Potential New Requirements for Returning Overpayments/Increased Self-Disclosures

In addition, the long-awaited final regulations implementing the rule requiring Medicare overpayments to be returned within 60-days could  have a major impact on providers, particularly if the regulations include a 10-year look-back period.

To read the full insights from Bloomberg BNA, click here.