Qui Tam

Health Care Compliance Officers Are the Frontline Defense to Medicare Fraud

By Nolan and Auerbach

Recently, Nolan & Auerbach, P.A. Partner Joseph E. B. ?Jeb? White was a guest lecturer during the opening session of the George Washington University Healthcare Corporate Compliance Program. This one-of-a-kind program provides a comprehensive corporate compliance education for current or aspiring corporate compliance officers. For the eighth time, Mr. White was the lone speaker from the qui tam community.

Oftentimes, there is an antagonistic relationship between compliance officers and the qui tam community. However, compliance officers are on the frontlines of the fight against Medicare fraud, so it is important to educate them about the available anti-fraud laws, including the federal False Claims Act and its qui tam provisions. Instead of turning a deaf ear to compliance efforts, the qui tam community could play an active role in stopping fraud before it happens.

On the flip side, compliance organizations have been slow to reach out to the qui tam community, fearful that educating compliance officers about whistleblower laws will only incite more qui tam actions. After years of working with compliance officers, Mr. White has noted that the opposite is actually true?educated compliance officers are more likely to diffuse potential qui tam actions, simply because they listen to employees who raise concerns about Medicare fraud. All too often, however, compliance officers alienate, isolate and humiliate concerned employees, pushing these employees to look outside of the corporate structure for support and remediation.

In a very real sense, the False Claims Act qui tam mechanism acts as a safety net for those frustrated employees who are unsuccessful in getting the attention of compliance officers. Moreover, for those compliance officers who appropriately act on fraud concerns and still run into corporate roadblocks, the FCA safety net is there for them, too.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.

Full post as published by Medicare Fraud 101 on November 17, 2010 (boomark / email).