By Scott Intner
I really enjoyed Day One at HCCA’s Compliance Enforcement Institute. In particular, session 101, which explored the necessary impact of the transition to paying on quality towards prosecutions under FCA for failing to deliver quality care. Or put another way, the criminalization of (gross) malpractice. The two speakers, George Breen of Epstein, Becker & Green and Jeffrey Dickstein, A-USA for S.D. of Florida, opposing counsel in a long running case, were everything one would hope for in speakers and professionals. The topic was fascinating as they, and we, explored the likelihood of the federal prosecutors going after providers for providing care that is grossly substandard, not just for exclusion or loss of licensure but for fraud under the FCA. It was a wonderful hour.
However it was also clear that the likelihood of most Compliance Officers having to confront such a prosecution in their organization, even years out, is remote. It would be a potential issue only for extreme cases. While we should be, and make sure our organization is, aware of the risks and the need for monitoring and vigilance. As compliance officers for non-outlier organizations, we live in the routine. The ongoing efforts to train, to monitor, to test, to continuously improve. In contrast, defense attorneys and prosecutors are used to dealing with the extreme cases. They get the headlines (and the material for great stories). Let’s keep working to minimize their volume.