decisionhealth Newsletters, Part B News - 2018 Issue 3 (March)
DOJ memos reduce danger of FCA prosecutions – but watch for this hidden threat
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Article Overview
This article explains how two recent Department of Justice memos may affect False Claims Act enforcement in health care, including limits on reliance on agency guidance, considerations for intervening in qui tam cases, and the broader compliance environment facing providers. It is relevant to compliance officers, health care attorneys, revenue cycle professionals, and providers who want to understand how DOJ enforcement priorities, whistleblower activity, and malpractice-related disclosure issues can affect exposure risk.
Why This Topic Matters
Changes in DOJ enforcement policy can influence how health care organizations are investigated, how qui tam matters are handled, and how compliance decisions are evaluated in civil fraud cases. Understanding the article helps readers assess potential FCA exposure and related litigation risk.
Article Sections
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DOJ memos and FCA enforcement
Introduces the two DOJ memos and their possible impact on civil fraud enforcement in health care. Discusses the role of agency guidance and government discretion in enforcement decisions.
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Recent trends show big recoveries
Summarizes recent FCA recovery trends and the continued focus on health care fraud. Covers the general use of data analysis, peer comparisons, and whistleblower-driven cases in enforcement activity.
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Change in lawyers’ roles
Describes how qui tam activity may arise from legal work connected to malpractice matters and the broader disclosure concerns this can create. Notes the importance of counsel awareness when potential FCA issues surface.
What You Will Learn
- How DOJ memo changes may affect False Claims Act enforcement priorities
- What kinds of health care fraud trends continue to draw government attention
- How qui tam activity can intersect with malpractice litigation and disclosure issues
- Why compliance and legal teams should monitor enforcement policy developments
Who Should Read This
- Health care compliance professionals
- Health care attorneys
- Revenue cycle and billing leaders
- Physicians and provider organizations
- Risk management and malpractice defense professionals
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