In the Report on Medicare Compliance, Phillips & Cohen partner Colette Matzzie highlights some likely priorities of the coming year for the US Department of Justice regarding healthcare fraud enforcement.
“There will be vigorous enforcement across the board,” predicts Washington, D.C., attorney Colette Matzzie, with Phillips and Cohen, which represents whistleblowers. “I think we will see continuing enforcement priorities and then kind of a renewed push.”
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Based on its statements and recent cases, DOJ has several FCA enforcement priorities in health care, Matzzie said. One is EHRs. The first generation of FCA cases against certain EHR vendors alleged their software didn’t qualify for the Medicare EHR incentive payment program and therefore caused their hospital clients to collect millions of dollars improperly. “But what we will see next are cases involving the relationships within EHR systems,” Matzzie said.
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The second priority is opioid enforcement. “DOJ and HHS and even the Drug Enforcement Administration are going to be interested in looking at every player along the chain,” Matzzie said.
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Matzzie said cases against Medicare Advantage plans (Parts C and D) are another DOJ priority in the FCA space. “An important case to watch is UnitedHealthcare Insurance, et al., v. Alex M. Azar II,” she said.
Read the entire article, “Outlook 2021: Expect ‘Vigorous’ FCA Enforcement; Prosecutor: Don’t Back Off Compliance.” (Subscription required.)