Healthcare fraud crackdown: What ASCs, physicians need to know

Healthcare fraud lawsuits are expected to continue to rise in 2024, with some practices more at risk than others.

Managed care companies, digital health providers and companies owned by private equity firms are three types of healthcare entities more likely to be involved in fraud enforcement, according to a Jan. 3 post by law firm Foley & Lardner.

Here is a breakdown of how practices an physicians can safeguard themselves from fraud allegations, according to the firm:

1. Be careful using new technology. Technologies such as artificial intelligence and remote patient monitoring are still in the process of receiving solidified compliance rules and regulations, which can lead to enforcement issues before rules are in place.

2. Avoid being an "outlier." Enforcement agencies are getting new capabilities and are able to view outliers based on provider prescribing tendencies, diagnosing habits and use trends. Practices and providers that can afford data mining to identify outlier trends can avoid becoming outliers themselves.

3. Keep records of claims to explain why services were used. This can avoid claims of ambiguous practice from patients and enforcers later.

4. Take precautions against data breaches. The Civil Cyber-Fraud Initiative, passed in 2021, aims to hold those who put information or systems at risk with ineffective or inefficient cyber security accountable. Practices should have safeguards in place to prevent unauthorized data access.

The firm concluded that practices should ensure they dedicate appropriate resources to compliance programs to avoid dealing with fraud allegations and enforcement.

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