tci Medicare Compliance & Reimbursement - 2010 Issue 2
COMPLIANCE NEWS: Are Internal Auditors Obligated to Report Adverse Findings to Medicare? Genesys Cardiology Qui Tam Lawsuit Raises Questions
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Article Overview
This article covers a Medicare False Claims Act qui tam matter involving a healthcare organization, with emphasis on alleged billing and documentation concerns in cardiology services. It also examines the broader compliance and ethics issue of whether internal auditors should report adverse findings externally, and why that question matters to healthcare providers, auditors, compliance teams, and legal counsel.
Why This Topic Matters
The topic is important for organizations that rely on internal audits, compliance programs, and self-reporting decisions. It highlights how billing disputes, whistleblower actions, and government enforcement can intersect in a healthcare setting.
What You Will Learn
- How a False Claims Act settlement can arise from alleged Medicare billing concerns
- Why internal auditors may face ethical and professional tensions when they uncover potential problems
- What general factors can influence whether an organization self-reports identified issues
- How healthcare organizations may respond to allegations involving billing and documentation
Who Should Read This
- Healthcare compliance professionals
- Internal auditors
- Revenue cycle teams
- Healthcare attorneys
- Physician practice administrators
- Risk management professionals
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