Featured Article

Move quickly to abjure wrongdoing as biller gets prison time for fraud

Posted By: Bret S. Bissey, MBA, FACHE, CHC, CMPE / March 22, 2016

Screen Shot 2016-03-17 at 3.14.52 PMBret Bissey,MBA, FACHE, CHC, CMPE, was interviewed by Roy Edroso of Part B News on the DOJ’s memo focusing on the increased prosecution that will target individuals and executives involved with crimes.

The full article can be read here.

Blow the whistle?

If you see something really wrong, you have to come forward to a compliance officer at your practice. “Being the intermediary between the provider and the Medicare trust fund, the biller has a heightened responsibility,” says Parrella. “She can’t just keep her head in the sand. She has an obligation to inquire further and if she knows something is not right, she has to act.” Tip: Have a process for employees to report problems.

“This is why the government is always talking about a ‘culture of compliance,’” says Bret S. Bissey, senior vice president, compliance services, MediTract, Chattanooga, Tenn. “The obligation is on the organization to have compliance policies.” You need a compliance officer and a process that allows employees with complaints to make them without fear of retribution.

If the compliance officer won’t act, the next step will be to report them. CMS has a Medicare Fraud Tip Line (1-800-MEDICARE) and the Office of Inspector General (OIG) has an online fraud reporting form. Or talk to a lawyer. “If you come forward quickly enough, you may even qualify for a whistleblower award under the False Claims Act,” says Mahany. Qui tam suits pay a percentage of the government’s recovery to the complaining witness whose case is taken up by the government.

Bret S. Bissey, MBA, FACHE, CHC, CMPE

Prior to joining MediTract, Mr. Bissey was the SVP, chief ethics and compliance officer at UMDNJ, where he successfully led the compliance program to adherence with a rigorous five-year Corporate Integrity Agreement with the DHHS/OIG that occurred following a Deferred Prosecution Agreement. Prior to UMDNJ, Bissey served as the director of the Regulatory Compliance Practice at IMA Consulting, the chief compliance and privacy officer at Deborah Heart and Lung Center (operating under a CIA) and the VP of compliance at Cabot Marsh/QuadraMed. Mr. Bissey earned a Bachelor of Science in business administration and marketing from Shippensburg University of Pennsylvania and an MBA in marketing and healthcare administration from Wilkes University. Mr. Bissey is a frequent national speaker on healthcare compliance and is the author of The Compliance Officer’s Handbook. He is a Fellow of the American College of Healthcare Executives and a member of the Health Care Compliance Association (CHC), American College of Medical Practice Executives and the Healthcare Financial Management Association.