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Dallas Business Journal:

As part of this year's efforts to reform health care, federal agencies have intensified their efforts to crack down on the multibillion- dollar industry swirling around Medicare and Medicaid fraud.

Dallas Attorney Richard Roper of Thompson & Knight in original article

As part of its aggressive tack, the Justice Department is moving from a complaint-based system to targeting suspicious billing patterns, he said. This means providers will have to put in place stronger compliance measures, he said.

Avoiding red flags
A tougher stance on health care fraud will mean more audits for health care providers, said Richard Roper, an attorney at Thompson & Knight in Dallas. Roper is the former U.S. attorney for the Northern District of Texas, serving from 2004 to early 2009.

Other developments are contributing to the trend, too. Changes to the federal False Claims Act, which encourage whistleblowers to take action against fraud, have resulted in a rise in such cases since the spring of 2009, Roper said. And fraud investigators have developed more sophisticated methods of looking at suspicious reimbursement patterns in their audits to uncover fraud.

It will be necessary for every company, whether it's a large company or smaller health care provider, to implement robust compliance programs that protect against fraud.

It will be critical to train employees to notice unusual methods of billing and coding, potential red flags, and to be proactive in addressing issues, Roper said. Such red flags can be the result of an honest mistake, he said. Not all companies that exhibit red flags are just out to cheat the government.

"A lot of problems you see come from a lack of knowledge," Roper said. "You see some companies taking shortcuts, whether they are intending to commit fraud or not."

If a problem does arise, companies should take steps to address that issue by doing an internal investigation and dealing with the matter, Roper said.
"The worst thing that a corporation can do is do nothing, until a government audit discovers the problem," he said.

http://dallas.bizjournals.com/dallas/stories/2009/12/14/story7.html

© 2009 American City Business Journals, Inc.