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Health care fraud and abuse enforcement: Relationship scrutiny

July 17, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

HHS OIG — Ensuring the Integrity of Medicare Part D

July 16, 2015 Comments off

Ensuring the Integrity of Medicare Part D
Source: U.S. Department of Health and Human Services, Office of Inspector General

In the 9 years since Part D began, OIG has produced a wide range of investigations, audits, evaluations, and legal guidance related to Part D program integrity. This work has resulted in the prosecution of individuals accused of defrauding Part D, as well as the identification of systemic program vulnerabilities that raise concerns related to both inappropriate payments and quality of care. OIG has made recommendations to strengthen Part D program integrity, and progress has been made. However, Part D remains vulnerable to fraud, as evidenced by ongoing investigations. OIG has prepared this portfolio to document key progress in addressing Part D program vulnerabilities and to highlight issues that need improvement.

See also: Questionable Billing and Geographic Hotspots Point to Potential Fraud and Abuse in Medicare Part D

Health care fraud and abuse enforcement: Relationship scrutiny

July 5, 2015 Comments off

Health care fraud and abuse enforcement: Relationship scrutiny
Source: Deloitte

Where is fraud and abuse enforcement headed in health care? One emerging area of interest is relationship scrutiny. Relationships can be complex in the business of health care: tracking and analyzing them is an important part of minimizing the fraud and abuse that may result from questionable relationships and improper influence.

Many organizations depend on analytics to understand their own performance. Insights and patterns within the data are often used to inform strategy and decision making. Researchers can apply analytics to identify external trends and factors that may impact businesses. To that end, Deloitte researchers used analytics techniques to examine the text of tens of thousands of federal regulations and identify emerging trends in health care fraud and abuse enforcement. The results are telling: Federal health care regulators are emphasizing relationship scrutiny in their fraud and abuse enforcement efforts. Also, discussion of health care fraud and abuse topics – including relationship scrutiny – is recurring, as evidenced by the cyclical rise and fall in frequency and relevance of keyword groups related to “enforcement,” “value-based care,” and “fraud and abuse.” The bottom line: discussion of these topics is present; relationship scrutiny is likely here to stay.

Minimizing the risk of health care fraud and abuse doesn’t have to be an impossible task. New insights can come from the application of analytics to an organization’s data sets. These insights, in turn, can be used to build a fraud and abuse risk-mitigation program.

This paper examines health care fraud and abuse enforcement drivers and laws, the cyclical trend of relationship scrutiny within the regulatory discussion, and how health care organizations can build a responsive, analytics-based program to address potential fraud and abuse. An effective program will likely enable organizations to identify risks in real time, adjust to mitigate them, communicate their importance, and learn from the regulatory and legislative landscape.

Canada’s Anti–Money Laundering and Anti–Terrorist Financing Regime: The Legal Profession’s Obligations

May 25, 2015 Comments off

Canada’s Anti–Money Laundering and Anti–Terrorist Financing Regime: The Legal Profession’s Obligations
Source: Library of Parliament

On 13 February 2015, the Supreme Court of Canada ruled that certain provisions of the Proceeds of Crime (Money Laundering) and Terrorist Financing Act that impose obligations on lawyers violate the Canadian Charter of Rights and Freedoms.

The decision, in Canada (Attorney General) v. Federation of Law Societies of Canada, confirmed that legislation cannot enforce obligations on lawyers that would undermine solicitor–client privilege.

In exempting lawyers from the Act, Canada – like the United States and Australia – is among the few Financial Action Task Force members that do not impose obligations on lawyers as part of their anti–money laundering and anti–terrorist financing regime.

According to the Task Force, criminals may use lawyers to facilitate illegal financial transactions, particularly when they are acting as financial intermediaries.

IRS — Victims of Identity Theft Continue To Experience Delays And Errors In Receiving Refunds

April 10, 2015 Comments off

Victims of Identity Theft Continue To Experience Delays And Errors In Receiving Refunds
Source: Treasury Inspector General for Tax Administration

Victims of identity theft continue to experience delays and errors in receiving refunds, according to a report publicly released today by the Treasury Inspector General for Tax Administration (TIGTA).

This audit follows up on a 2013 TIGTA report which concluded that the Internal Revenue Service (IRS) was not providing quality customer service to identity theft victims. The objective was to determine whether the IRS is improving its assistance to victims of identity theft.

On average, the IRS took 278 days to resolve the tax accounts of identity theft victims due a refund, according to TIGTA’s review of a statistically valid sample of 100 identity theft tax accounts resolved in the Accounts Management function in Fiscal Year (FY) 2013. That is an improvement over the average 312 days it took the IRS to resolve tax accounts of identity theft victims due a refund in FY 2012.

National White Collar Crime Center Annual Report 2014

April 9, 2015 Comments off

National White Collar Crime Center Annual Report 2014 (PDF)
Source: National White Collar Crime Center

Throughout 2014, NW3C continually endeavored to empower law enforcement through innovative solutions, both by creating new tools and courses and by finding ways to improve existing processes. This report describes the impressive results obtained from consistent, dedicated effort.

In 2014, NW3C delivered classroom and web-based training to 20,593 law enforcement personnel. The number of people trained represents a 39% increase over 2013, due in large part to NW3C’s goal to make more courses accessible online.

By year’s end, NW3C had provided over 8,000 online training sessions covering a wide variety of subjects of interest to law enforcement, including intellectual property, identifying and seizing electronic evidence, social media, encryption, and legal concerns for digital evidence. Made possible in part by funding from BJA, these online training courses were offered free of charge to qualified law enforcement personnel throughout the nation, enabling them to conveniently obtain the skills needed to effectively serve their communities.

Assessing the Merits of Photo EBT Cards in the Supplemental Nutrition Assistance Program

March 31, 2015 Comments off

Assessing the Merits of Photo EBT Cards in the Supplemental Nutrition Assistance Program
Source: Urban Institute

In seeking to reduce the trafficking of benefits in the Supplemental Nutrition Assistance Program (SNAP), states are considering policies to require that SNAP electronic benefit transfer (EBT) cards include a photograph of the household head. Such policies have sparked controversy, placing in direct conflict the desires to bolster program integrity with the statutory rights of SNAP household members to utilize their program benefits and receive equal customer treatment. Drawing on Massachusetts’ 2013 implementation of a photo EBT policy, this brief suggests that such policies are not a cost-effective means to promote program integrity and may hinder benefit access

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