Share this article:

The government will continue ramped-up efforts against healthcare fraud cases that involve program exclusions and civil monetary penalties, officials shared on Monday.

The Office of Inspector General increased the number of CMP-related fraud cases investigated during the past fiscal year, OIG Chief Counsel Gregory Demske said during a talk for the Health Care Compliance Association. The OIG resolved 110 exclusion and CMP fraud cases in the past year, Demske said.

Demske predicted the trend will continue, especially with OIG’s recent addition of a litigation team to handle Medicare and Medicaid fraud cases.

The OIG also will show a renewed focus on holding individuals responsible for fraud cases, rather than settling with corporations, Demske said according to a report in Bloomberg BNA. The policy of holding individuals accountable was introduced in September.

Blogger comment:

This OIG Gestapo approach to enforcement has failed and it is evident that the regulators aren’t doing their job.  Their job should be to work with the providers not against them.  How much different would the nursing home results be if –

1)  The surveyors were there to find something right and reward providers for doing it right according to the industry standards not meaningless academic standards promulgated by Congress.

2) The awards for excellence were for Quality of Life not how to change a diaper and pass pills on time.

3)  Set up a complaint system that works for the improvement of quality of life not against the provider that is striving to fix problems.  The complaint must be delivered to the Administrator not to the regulators Gestapo “Gotcha System” and the provider is accountable if the problem isn’t fixed.

4) The Medicare and Medicaid programs were to pay for Skilled Nursing results not average payment for daily rent and pills … Medicare has to pay for a 100 days of restorative care and discharge planning when warranted to reduce readmissions and ER visits.

5) The nursing home associations were to take responsibility for monitoring quality and handing out awards on quality of life not the five star system dictated by the Gestapo regulators.  Such a system exists … the Illinois six star system outlined in my books worked because it surveyed for reinforcing the nursing homes efforts not beating them down.  Incentives were aid for attaining each of the six stars … quality of environment, documentation, low staff turnover, family involvement, community involvement and meaningful restorative programing for the all patients.  Each year the six star facilities were recognized as the best in the state … and they were.

In this scenario everyone wins not just the regulators using the bully pulpit approach with threats and civil money penaties.  Jerry Rhoads