Bass, Berry & Sims attorneys Brian Roark and Matt Curley examined key findings following the release of the firm’s annual Healthcare Fraud & Abuse Review. “Healthcare companies must continue to invest in compliance efforts as fraud enforcement hasn’t wavered at all during significant political and healthcare industry changes over the last decade,” noted Brian. “In an election year, where health policy is a crucial issue, we don’t expect anything but continued robust enforcement efforts across all healthcare sectors.”

In a Q&A article for Nashville Medical News, Matt and Brian answered the following questions addressing the trends and issues highlighted in the Review:

  1. Bass, Berry and Sims has produced this annual report since 2012. What overall trends have emerged?
  2. Was there a particular segment of healthcare that was more vulnerable to FCA actions in 2019?
  3. Speaking of Stark and the Anti-Kickback Statute, what should providers know about proposed changes and how those might impact the way they practice and refer?
  4. What about the issue of medical necessity?
  5. With both traditional and professional relators on the lookout for opportunities to file FCA claims, what should providers keep in mind?
  6. There are many private equity firms in Nashville that are instrumental in scaling up healthcare companies. What liability do they face if an FCA action is brought against a company in which they are an investor?
  7. What course of action should someone take if facing an allegation of fraud or abuse or if an issue comes to light through a self-audit?

“The drive for transparency in healthcare is making claims data and similar information available to analytics firms looking to make FCA cases,” explained Matt. “Providers must understand what their publicly available data show, because the government and relators see this data as fertile ground for FCA cases.”

The full article, “Bass, Berry & Sims Releases Annual Healthcare Fraud & Abuse Report,” was published by Nashville Medical News on March 9 and is available online.