Linda Baumann Quoted in Bloomberg BNA on 2013’s Top Health Care Fraud Issues

The article reported that, “Health care attorneys and industry experts tell BNA that providers will have to prepare for an increased emphasis on individual exclusions, more False Claims Act cases, an expanded scope for program integrity contractors, and a focus on the use of electronic health records to fight Medicare and Medicaid fraud.” The article also noted the likelihood of increased Stark Law enforcement through False Claims Act cases would continue in 2013.

Ms. Baumann said that while questions remain over the final content of the Department of Health and Human Services Office of the Inspector General’s revised guidelines for 2013, their publication will likely lead to an increase in exclusions. “I’d expect the new guidance to signal greater use of the OIG’s exclusion authority based on their continuing expansion of their investigative and prosecutorial authorities in almost every area,” said Ms. Baumann. She added that the new guidance would bolster the OIG’s pursuit of lengthier exclusion periods, including against individuals.

With regard to future government activities, including investigations by the recovery audit contractors (RACs) and zone program integrity contractors (ZPICs), Ms. Baumann said she expects there will be a substantial increase in 2013. “This level of investigative activity is incredibly burdensome for hospitals and other providers, in terms of the time and resources that have to be devoted to compliance,” said Ms. Baumann, “both in terms of operating their compliance program and responding to government investigations.”