Officer of Inspector General’s (OIG) Top Ten Tips to Avoid Enforcement Actions

Several years ago, I had the opportunity to listen to D. McCarty Thornton, former OIG Chief Counsel, speak on trends in fraud and abuse enforcement to members of the National Health Lawyers Association. Thornton identified anti-kickback violations as the hottest area of risk for health care providers. Thornton shared the following list of top ten tips to avoid OIG enforcement actions, all of which are still applicable today: 

  1. No personal favors to referral sources. 
  2. Don’t stick out of the crowd—Thornton warned that the government often looks for “low hanging fruit” as an easy target for investigation. 
  3. Be wary of going along with the crowd that seems to be taking risks. 
  4. Analyze proposed arrangements by thinking about the basic purposes of the statute—Thornton said: “the government is unlikely to go after a deal unless there is some sort of harm to [a federal healthcare] program or the patients”. 
  5. Get as close to a fraud and abuse safe harbor as possible or document business reasons why full compliance is not possible. 
  6. While paying/receiving fair market value is not an official safe harbor because the government views it as too open to interpretation, it still can afford excellent overall protection if good faith fair market value is documented. 
  7. Preserve credibility and avoid obstructing justice by shredding or altering documents, withholding information, or telling half-truths. 
  8. Check compliance on an ongoing basis once you have assessed a particular deal’s risks. 
  9. Document, document, document. 
  10. “Greed is not good”—excessive compensation or return on investments is a red flag to investigators. 

One of the best ways to avoid fraud and abuse risk is to adopt an effective corporate compliance plan. W+L is experienced in creating corporate compliance plans for provider groups and individual practitioners in a cost-effective way. For more information contact Orly Rumberg at (513) 852-6034. 

 

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    Orly R. Rumberg

    Orly R. Rumberg's health care area of practice provides essential support to health care providers including physicians, hospitals, pharmacies, health systems, and long-term care clients with respect to corporate and regulatory aspects of health care delivery.

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