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Legal: Maintain culture of compliance

Legal: Maintain culture of compliance Q. How do I decrease my risk of FCA liability?

A. Providers can decrease the risk of False Claims Act liability by building and maintaining a culture of compliance in all aspects of their business. For example, suppliers should keep abreast of changes in federal health care program (e.g., Medicare) regulations and ensure that their employees and contractors receive current and refresher training on relevant requirements.

Providers should also have (and enforce) compliance policies and procedures that are in harmony with laws, regulations and supplier standards. Additionally, periodic self-audits will help suppliers identify and correct potential issues. Key risk areas include accreditation, marketing practices, billing, documentation of medical necessity, and referral relationships.

It is also important that individuals know they can bring potential issues to a company's attention without fear of retaliation. Indeed, many FCA whistleblowers allege that, before bringing a whistleblower lawsuit, they attempted to bring an issue to a company's attention but were either ignored or punished. To enhance communication and allay fear of retaliation, it is common for companies to use a compliance hotline or similar process that permits anonymous reporting and follow-up communication between the reporter and the company. 

In sum, to help reduce the risk of FCA liability, providers should strive to create a culture of compliance in which individuals know and follow the rules, and know that there will be no retaliation if they identify a compliance issue in good faith. Potential issues should be identified, investigated and corrected as soon as possible.

Jill Vogel is a senior health care attorney at Brown & Fortunato, P.C. Reach her at [email protected]


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