Health & Human Services is looking to ratchet up public pressure on healthcare fraudsters who refuse to improve their corporate business practices after getting caught.
Gregory Demske, chief counsel to the Office of the Inspector General, tells Bloomberg that the entity plans to begin publishing a list of what it considers providers at a high-risk for healthcare fraud on or around Oct. 1. Those are defined as providers who fraud allegations, but refuse to enter into corporate integrity agreements.
Demske told the publication that the move is about helping the public make more informed decisions about care, rather than forcing providers to operate differently.
“The purpose of this is to provide transparency and information, it’s not done to change behavior,” Demske said.
HHS OIG has its own Fraud Risk Indicator, which provides insight into what the agency considers “highest risk” for illicit activities. Bloomberg notes, in its analytics database, of 865 settlements since 2006, 621 did not include a corporate integrity agreement. However, in most cases, the agency doesn’t seek one, Demske noted. Those who fall onto the public risk list will be of a very narrow subset of providers, officials said.
In most recent instances, skilled care providers have complied with the corporate integrity request as a way to demonstrate its commitment to ethics. Last year a Tennessee-based long-term care provider agreed to pay $5 million to resolve claims that one of its facilities billed Medicare and Medicaid for “worthless services,” along with entering a CIA. Spring Gate Rehabilitation and Healthcare Center in Memphis did the same earlier this year, as did electronic health records vendor eClinicalWorks in 2017.
