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