No medical practice wants to be the target of a False Claims Act (FCA) accusation. Penalties for violating the FCA include fines of up to $11,000 per claim, attorney costs, exclusion from Medicare, and having to pay back triple the damages that the government incurs. But if you want to avoid FCA accusations, your best bet is to keep your employees happy.
Here’s why: Disgruntled employees are among the biggest sources generating FCA cases. These whistleblowers know your practice intimately, including any coding, billing or compliance errors that you’ve been making. They may not even tell you that they think you’re submitting claims incorrectly before they report it to the government. The reason? Whistleblowers collect up to 30 percent of the money that the government recovers based on your violations, which can make whistleblowing a very lucrative pursuit.
To identify compliance issues early and avoid False Claims Act complaints from disgruntled employees, employ a four-pronged approach.
1. Perform an Annual Compliance Survey
It’s a good idea to ask your employees to answer an annual survey about compliance issues at your practice. Ask open-ended questions, such as “are you aware of any concerns or compliance issues?” or “What areas of compliance improvement do you suggest?”
This way, the employees will have an opportunity to tell you the issues they see. And, if they say they’ve never seen anything untoward at your practice, you’ll have that in writing if they ever try to blow the whistle on FCA violations they say they’ve noticed.
2. Ask About Compliance at Exit Interviews
When an employee leaves your practice, it’s a good idea to perform an exit interview to assess what they thought of the workplace and if they have any information to share that would help you in the future. During that meeting, you should also ask about compliance. Did they see anything they found unusual? This can help you correct issues that departing employees have noticed.
3. Offer an Anonymous Way to Report Violations
Some employees may want to tell you about compliance violations, but they fear retribution—so they go straight to the feds. To head off this issue, you can provide staff members with a way to anonymously report violations. This may be an old-fashioned complaint box, a website, or even a Google form. Take all complaints that come in seriously and investigate them thoroughly. Don’t try and track down the employee who reported a violation—that would go against the “anonymous” nature of the reporting structure, and might discourage future reports.
4. Take All Complaints Seriously
In some cases, employees do complain about compliance issues, but employers don’t follow up. If this happens at your practice, you could face serious consequences down the line. A False Claims Act whistleblower who has already called out issues, only to go ignored, will be seen as a strong witness in a case against you.
Follow up on all complaints, whether anonymous or in person. After you resolve any issues, hold a training session at your practice to make sure the same problems aren’t seen again in the future. This is the best way to close the loop and show your staffers that you consider compliance a paramount concern, and that you will always take complaints to heart.
Want more tips about avoiding FCA violations? Check out the online training, “Stop Whistleblower False Claims Act Complaints and Resulting Penalties.” During the 60-minute session, healthcare attorney Kelly Holden, JD, will walk you through the essentials you must know to avoid whistleblower complaints.
 |
Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. |
|
|
|