Picture the word FRAUD as a flashing warning sign complete with an obnoxious, ear-splitting siren, and you get the idea of how important it is to avoid any hint of it in your healthcare organization. Deception at this magnitude damages your organization on many levels. It impacts your reputation and could subject you to millions of dollars in court judgements and settlements. Not to mention, you could lose hundreds of thousands of dollars in defending your organization in a court case—even if you ultimately win.

In 2014, the government obtained $2.3 billion from healthcare civil cases involving fraud and false claims again Medicare, Medicaid, and other federal healthcare programs.1 These fraud indictments included charges for improper physician referrals and billing for medically unnecessary services. Cases were brought and won against hospitals, health systems, home health services, and more.

Plus with financial incentives for whistle-blowers, their attorneys, and the federal government, the enforcement trend is likely to continue. According to Becker’s Hospital Review, in 2012 alone, whistle-blowers “received a total of $284.3 million from federal qui tam settlements and judgments.” Becker’s also noted that the government’s return on investment was estimated to be 20 to one.2

Compliance is the Answer

So how do you avoid fraud? The answer is compliance. Healthcare regulations are constantly changing, and it can be difficult to keep up with new rules and regulations. That’s why a strong compliance program run by an effective compliance officer is essential. The Federal government is not going to give you a free fraud pass just because you didn’t know a new law was in place.

In an article for Corporate Compliance Insights, Healthcare Fraud Defense Attorney Anthony C. Vitale, recommended several actions healthcare organizations could take to use compliance to stop fraud, including

  • Detail in writing how claims are to be submitted,
  • Conduct internal risk assessments and audits,
  • Set up a process for employees to report noncompliance and review any complaints, and
  • Educate employees on how to prevent fraud. 3

With IntelliCentrics , you can successfully incorporate all the recommended elements of a successful compliance program. From training to reporting, provides the tools you need to fight fraud. Plus, SEC3URE facilities have continual access to the latest changes in regulations and requirements.

Fraud can happen to any healthcare organization of any size from a multi-hospital system to a physician’s office. Don’t pretend it can’t happen to you; stop fraud and protect your bottom line.


  1. http://health.wolterskluwerlb.com/2014/11/kusserow-on-compliance-doj-reports-over-700-whistleblower-cases-in-2014/
  2. http://www.beckershospitalreview.com/legal-regulatory-issues/identify-trends-in-false-claims-act-enforcement.html
  3. http://www.corporatecomplianceinsights.com/compliance-first-step/

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