In an expert analysis published by Law360, Partners Ericka Aikenand Kevin Lamb,and Associate Charlotte Mostertzdiscuss theUS Department of Justice's (DOJ) recently announced criminal indictment related to the Medicare Advantage program and point to the importance of functioning compliance programs.
Excerpt:"Indeed, the DOJ has said recently that it will increase the number of investigations into Medicare Advantage fraud. Heightened scrutiny may result in additional criminal prosecutions of individuals and even companies alongside increased civil enforcement. HealthSun is also the latest example of a company benefiting from declination under the DOJ's public commitment to providing incentives for voluntary self-disclosure and swift remediation."
HealthSun Health Plans Inc., allegedly falsified diagnoses submitted to the Centers for Medicare and Medicaid Services, leading to millions of dollars in overpayments. In this case, the DOJ declined to prosecute HealthSun based on its timely self-disclosure, cooperation and remediation efforts. Aiken, Lamb and Mostertz highlight the DOJ's focus on combating fraud in the Medicare Advantage program and the importance of the ability to detect and address potential risks to a company, including employee misconduct, promptly and effectively.
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