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Oct 2019
21
October 21, 2019

U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Top Priorities

The OIG’s Acting Inspector General, Joanne M. Chiedi (IG), recently discussed the department’s top six enforcement priorities at the American Health Lawyers Association’s Fraud and Abuse Conference in Baltimore, MD. Her remarks are a guide to what every health-care organization and health-care professional needs to know to remain compliant and protect their business and clients from government enforcement actions (civil and criminal).

According to Ms. Chiedi, HHS and OIG will be focused on the following areas as top priorities regarding fraud investigations and enforcement for the foreseeable future:
 
  • The ongoing shift to value driven and coordinated care for ACOs and MSSPs
  • Detecting and prevent Medicaid fraud
  • Aggressive efforts aimed at prescribers and pharmacies to combat the opioid epidemic
  • Ensuring integrity and true quality of care in hospice, home health and group homes
  • Maximizing cybersecurity for HHS programs and providers
  • Protecting children that receive services from HHS programs and overseeing those services

HHS and OIG are taking internal steps to support these top priorities. There has been significant investment in data-driven technology and the OIG has recently hired its first ever chief data analyst (actually the first ever in any Inspector General office). The OIG is collecting a “pedabyte” of digital data every year (i.e., the equivalent of 1.5 million CD roms) and sharing data with both public and private partners. OIG is focusing the analysis to target the way providers and suppliers are actually using data to deliver care.

The IG noted technology that empowers patients can also be used to facilitate fraud, which is becoming more pervasive. The OIG is also focused on scrutinizing providers and tech companies that engage in information-blocking practices that interfere with, prevent or materially discourage access, exchange or use of electronic health information. Information blocking prevents better health care. Providers that are prevented from sharing data permissibly via electronic means are forced to use fax machines or other outdated methods that are far less efficient. 

In light of the continuous shift towards data technology in health care, the OIG is acutely aware that cybersecurity is a serious risk. Cybersecurity compliance needs to be as important as traditional compliance. This is especially true to combat fraud in a world where more and more billing and coding programs have built-in artificial intelligence (AI) to help maximize reimbursement based on algorithms that are designed to analyze physician documentation and improve coding accuracy. This raises questions about the continuing compliance landscape. What if AI recommends expensive treatments for beneficiaries and no treatments for uninsured patients to maximize reimbursement? How can AI improve diagnostics and make billing more accurate and streamlined for compliance?

Ms. Chiedi also noted that many existing and emerging tech companies looking to solve persistent health care problems have no real experience in the industry. These companies are searching for opportunities but need to be aware of the potential pitfalls as well. Many are attempting to dive into the industry with little to no awareness of the breadth of compliance required. The immediate pressure to perform and produce results puts compliance in the backseat. These new companies need a knowledgeable guide to lead them through the regulatory environment to help them put the right safeguards in place and to make compliance an absolute mindset.

The IG concluded her remarks by telling the audience that the department is driven to produce positive change and is using data and technology to oversee their own programs to make the system better at delivering modern health care. The OIG’s goal is to increase speed and advance accuracy and outcomes.

For new companies entering the medical field for the first time, and even for longstanding players in the industry, it’s critical to recognize that while the industry is changing, the absolute necessity to stay in compliance is not; compliance remains paramount. 

Warner’s Health Law attorneys have been practicing in the medical-legal field for more than three decades. Whether you are new to the industry or have been engaged for years, we can help you navigate the compliance minefield to avoid costly mistakes and scrutiny from federal and state regulators. We are also well equipped to help respond to internal and external investigations and audits that raise compliance questions, and we provide defense and guidance regarding civil and criminal enforcement actions based on the federal False Claims Act, Physician Self-Referral Law and Anti-Kickback Statute.

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