Thursday, March 22, 2012

Phillips & Cohen lawyer offers seven tips for successful whistleblower program

Mandatory percentage awards, protection of whistleblowers' identities, and encouragement of reporting through internal compliance programs are among the elements of a successful whistleblower program according to Phillips & Cohen attorney Erika Kelton.

In an article on the Forbes site Kelton points out that that the success of the US False Claims Act has resulted in the return of over $35 billion to the US Treasury. The adoption of similar legislation in other countries could benefit their taxpayers as well.

Kelton notes that the Securities & Exchange Commission had a tip line for years before Dodd-Frank created the SEC whistleblower program. But the tip line didn't motivate the agency to investigate the evidence it received of Madoff's wrongdoing. An effective program must encourage these investigations.

Britain's Serious Fraud Office, responsible for the enforcement of the Anti-Bribery Act, is facing serious cutbacks in its enforcement budget. Whistleblower incentives could promote the public-private partnerships that have made the False Claims Act such an effective tool in fighting fraud and corruption.

NY State goes easy on Medicaid audits in response to industry pressure

New York State had been off to a good start in cracking down on health care fraud. The New York Times reports that efforts under former Gov. George Pataki resulted in $1.5 billion in overpayments being recovered in 4 years and other states rushed to emulate New York.

But pressure from the politically powerful health care industry has resulted in a noticeable easing in enforcement.

In 2011 Gov. Andrew Cuomo dismissed the state's first Medicaid Inspector General, James Sheehan, a former Assistant United States Attorney well-known for his efforts against health care fraud. Sheehan had been extremely successful, exceeding recovery targets. The Times says that his successor, James Cox, was told to cooperate with providers on changes in auditing methods.

Tuesday, March 06, 2012

Health care compliance educational resources from OIG

The Dept. of Health and Human Services Office of the Inspector General has developed a Compliance 101 page to help health care providers, practitioners, and suppliers understand the health care fraud and abuse laws and the consequences of violating them.

The resources include webcasts, podcasts, booklets and other materials, highlighting risk areas, setting forth statutory requirements and recommending best practices for compliance programs in various settings.