Compliance is an enormous and critical focus for the healthcare industry. The focus on different areas of compliance ebbs and flows as compliance professionals gain awareness of where accrediting bodies and regulators are spending more of their focus. To understand where the industry is heading, a team of content experts from HCCS, A HealthStream Company, recently attended the Health Care Compliance Association’s 2018 Enforcement Conference. Here is a list of topics that were covered:
The False Claims Act is always on the agenda as it continues to be the most effective law the government has for snagging healthcare providers in the fight against fraud, waste and abuse. And, with its qui tam, or whistleblower provision, it is also the most powerful. The qui tam provision allows anyone to file a False Claims Act suit on behalf of the government. Should the suit be successfully prosecuted, the plaintiff receives a share of the monies recovered.
As the False Claims Act is a ubiquitous problem, cybersecurity follows closely behind. While news of cybersecurity crimes has become commonplace, it is disturbing to learn that the top information security risks in healthcare are associated with employees! Half of breaches are due to lost devices containing unsecured protected health information (PHI). Many of the remaining privacy breaches are associated with identify theft, tax fraud and financial fraud by employees. There are also breaches caused by improper mailings, errant emails and faxes but, the largest breaches have been the result of hacking.
The HHS Secretary has declared a public health emergency in response to increased use and abuse of prescription opioids. Professional licensing boards, federal agencies, local law enforcement and multiple provider types are on the front lines of this serious epidemic. Investigative and enforcement actions are originating from a variety of sources under these agencies including the Opioid Fraud and Abuse Unit, Prescription Interdiction and Litigation (PIL) Task Force and data analytics.
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