Federal prosecutors aren't just fining companies anymore. They're putting leaders in the crosshairs.
In this eye-opening episode of Compliance Deconstructed, hosts Jessica Zeff, Lorie Davis, and Elvan Baker unpack the Hertel & Brown case and why owners (not just businesses) are facing the consequences.
Throughout this episode, they reveal how a network of billing scams, data manipulation, and oversight failures resulted in criminal charges for not only executives but also the compliance officer.
Healthcare fraud can include overbilling, upcoding, billing for services not rendered, and data tampering, all of which are deliberate strategies rather than simple mistakes. This episode explores how organizations can detect red flags, improve internal controls, and build a culture of accountability to prevent systemic fraud.
A pivotal moment in the discussion highlights the concept of “impossible days,” where clinicians were allegedly billed for more hours than they actually worked…pretty much an unmistakable sign of fraud. The hosts also emphasize the importance of strong EMR audit trail reviews and avoiding shared login credentials, which can mask unauthorized actions.
You’ll also discover the legal consequences for individuals involved in fraudulent schemes, underscoring that corporate shields do not protect against personal liability. Practical tips are offered for building a resilient compliance program that not only meets legal standards but also supports ethical, transparent healthcare operations.
Key Takeaways
- Fraud is often systematic and intentional, not a one-time oversight. Look for patterns, not just isolated errors.
- "Impossible days" are a critical red flag, where billing exceeds physical capability and must be investigated.
- Compliance officers carry personal liability and must be qualified, empowered, and proactive to avoid complicity.
- Weak internal controls and oversight failures are common gateways for fraud to persist undetected.
- Shared EMR credentials and data manipulation present major legal and ethical risks in healthcare organizations.
- Regular audits, employee training, and a culture of compliance are essential to detect, prevent, and report fraud effectively.
Learn more about Healthcare Compliance and discover how Simply Compliance can help your company at simplycomplianceconsulting.com.
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