Category:Fraud & Abuse
Home Health Care: Cost-Effective, Convenient, and Vulnerable to Fraud
Home health agencies (HHAs) provide health care services to assist individuals with a disability, or who are ill, injured, or elderly. It is a cost-effective and convenient method of receiving quality care that is provided from the comfort of the patient’s own home. While HHAs have been around for years, primarily to serve the elderly and avoid hospitalization, the post-pandemic “at-home” era has made it the fastest-growing healthcare industry in the country. However, the high demands and good intentions of instilling home health agencies come with its adverse counterpart- fraud and abuse.
Our American Government: a Self-Serving Entity?
As of September 2022, the current Congress has an approval rating of just 17% – an ignominious reality – and a series of recent investigations won’t serve to ease the mounting public frustration. Insider recently identified at least 72 members of Congress in noncompliance with the Stop Trading on Congressional Knowledge Act (STOCK). This revelation – among others – has prompted a push for the enactment of more stringent congressional stockholding limitations.
Jarksey v. SEC and the Future of Administrative Adjudications
On May 18, 2022, the United States Court of Appeals for the Fifth Circuit issued a novel and divisive decision that greatly restricts the administrative enforcement powers of the SEC and its use of Administrative Law Judges (ALJs) in Jarksey v. SEC. Although much deliberation has been had over the implications and immediate impact of this ruling, the takeaway is that the Securities and Exchange Commission (SEC) may be facing significant challenges to its internal enforcement procedures in the near future.
Possible Pitfalls of the New DOJ Compliance Policy
In March 2022, the U.S. Department of Justice (DOJ) introduced a new policy idea that requires a Chief Compliance Officer (CCO) undergo certification. This certification requires CCOs to attest at the end of company resolutions that their compliance program is reasonably designed to detect and promptly remedy behavior suspected or known to be in violation of applicable laws. The new policy is part of an effort to take more proactive measures against criminal behavior and activities such as fraud, bribery, corruption, etc. The certification is also aimed at empowering the CCOs as they speak on behalf of their company’s obligations to the compliance program.
The AMLA – Blowing the Whistle on Fraud
Whistleblowing – a powerful weapon in the arsenal of defense against fraud – is a highly effective tool utilized by the government to enforce regulatory compliance. Nevertheless, many employees remain hesitant to initiate criminal proceedings. In 2021, in an effort to dispel such concerns and to empower potential whistleblowers to take action, Congress enacted the Anti-Money Laundering Act (AMLA).
The SEC and Its ESG Investment Disclosure Proposal
The Securities and Exchange Commission (SEC) established the Environmental, Social, and Governance (“ESG”) Task Force in 2021. In March and May of 2022, the SEC proposed a disclosure rule “forcing publicly traded companies to disclose how climate change could threaten their businesses and describe their contributions to global warming.” The rule further accentuates the SEC’s mission “to protect investors, maintain fair, orderly, and efficient markets, and facilitate capital formation.” However, the proposal has faced substantial opposition, as some believe the proposal exceeds the SEC’s authority.
Therano-no: Key CLIA Compliance Issues
Janaki Padmakumar Associate Editor Loyola University Chicago School of Law, JD 2023 In one of the greatest fraud cases of the last decade, Elizabeth Holmes, founder and CEO of Theranos, was convicted of four federal fraud charges on January 4, 2022. Theranos was a private healthcare startup that claimed have invented a novel blood testing …
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Innovation in Healthcare: Physician Payment and Automation
In the fight against COVID-19, healthcare innovation has been unprecedented. New technology, protocols, and laws have changed the way healthcare functions. However, physician compensation remains complex, burdensome, and often contentious. Physician compensation has always invited compliance risks, operational bottlenecks, and administrative burdens, but now, innovative hospitals are simplifying the process with automation.
Insider Trading Isn’t Illegal if You Are a Member of Congress
Jon Ossoff, the freshman Senator from Georgia, has made it clear that he intends to put forth a bill that would ban members of Congress from trading individual stocks. This is a policy that seems likely to fail, but that doesn’t make it any less necessary. It is estimated that members of Congress and their families bought and sold over $500 million worth of assets. That’s not to say that all these trades were based on information not available to the general public, but it is clear that there is a massive conflict of interest in allowing law makers to trade stocks when their job is intrinsically tied to making decisions that affect the price of stocks.
White House Issues Guidance Regarding Fighting Corruption
On December 6, 2021, the White House issued a consolidated federal strategy regarding fighting corruption that threatens national security. The memorandum directed a number of federal departments to conduct interagency reviews that allowed them to come together and proceed with a joint strategy to combat corruption in the United States.