DOJ to Come After ‘Culpable’ Individuals in Fraud Cases; AIS Newsletter Examines the Impact on Corporate Compliance

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The Sept. 14, 2015, issue of Atlantic Information Services’ Report on Medicare Compliance takes an in-depth look at a new Department of Justice memo focusing on individual accountability in fraud cases.

A memorandum issued late last week by the Department of Justice (DOJ) puts a major emphasis on individual accountability in fraud cases. According to the Sept. 10 memo, corporations will no longer be able to settle civil or criminal fraud cases unless the names of people involved are divulged. The Sept. 14 issue of Atlantic Information Services, Inc. (AIS) Report on Medicare Compliance (RMC) takes a close look at the memo, also examining the impact it will have on corporate compliance and compliance culture, with one compliance expert telling the newsletter that the memo may be a turning point.

“This will make it harder for senior management to ignore compliance officers,” former federal prosecutor Robert Trusiak tells RMC. “The act of senior managers ignoring compliance officers makes a direct link between the culpable corporate action and senior managers’ knowledge of culpable corporate action.” It will be more difficult for C-suite executives to avoid liability based on a claim of ignorance on many compliance issues — for example, upcoding, Stark violations or medically unnecessary services — if the compliance officer has reported these problems.

“One of the most effective ways to combat corporate misconduct is by seeking accountability from the individuals who perpetrated the wrongdoing,” the memo says, which was signed by Deputy Attorney General Sally Quillian Yates. “It deters future illegal activity, it incentivizes changes in corporate behavior, it ensures that the proper parties are held responsible for their actions and it promotes the public’s confidence in our justice system.” And yet, Trusiak tells RMC, prosecutors probably won’t have to sacrifice settlement dollars from corporations either.

Visit https://aishealth.com/archive/rmc091415-01 to read the article in its entirety, including a summary of the six-step procedure detailed in the memo that DOJ and U.S. attorneys must take in investigating corporate misconduct.

About Report on Medicare Compliance
The industry's #1 source of timely news and proven strategies on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers, the award-winning Report on Medicare Compliance identifies and provides valuable guidance on dozens of high-risk billing and documentation problems and foreshadows the next moves of federal enforcers and their armies of RAC, ZPIC and MAC auditors. “The best information there is for hospital compliance officers,” the 8-page weekly newsletter includes insights and strategies not available anywhere else.

Since 1992, Report on Medicare Compliance has been written by Nina Youngstrom, who has a reputation for being one of the most knowledgeable journalists and incisive writers in the field. With excellent contacts at the IG's office and at CMS, and strong relationships among industry experts and compliance officers, each issue of Report on Medicare Compliance contains exclusive, inside news. Visit http://aishealth.com/marketplace/report-medicare-compliance for more information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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Jill Brown, Executive Editor
Atlantic Information Services
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