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Health Care Practice Co-Chair Kirk Nahra Discusses 2013 Anti-Fraud Outlook
The U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) plans to issue updated guidance this year on its authority to exclude certain individuals and entities from federally funded health care programs. Fraud and abuse convictions are among the violations that can trigger exclusion from programs such as Medicare and Medicaid under current law.
Mr. Nahra said he doesn’t expect the revised guidelines to provide the health care industry with any clarity as to the limits of the OIG’s exclusion authority.
“I have little expectation that this guidance will make any clearer where their authority lies for exclusion,” Mr. Nahra told Bloomberg BNA. “It is very broad and vague and I expect it will remain that way.”
Mr. Nahra said electronic health records (EHRs) are likely to be a “fertile area” for potential fraud this year. While law enforcement will be paying close attention, fraudsters are likely to be one step ahead, he said.
The OIG also plans to revise the self-disclosure process that lets health care providers voluntarily report potential fraud in federal health care programs. Mr. Nahra was among attorneys who said the revisions are unlikely to prompt more providers to self-disclose.
Absent a “real, clear and consistent incentive to voluntarily disclose,” providers will use the program sparingly, Mr. Nahra told Bloomberg BNA.
Mr. Nahra also said he doesn’t expect much success from a public-private partnership that the Obama administration launched last year to combat health care fraud. He noted that past efforts to link public and private anti-fraud efforts have failed.
“While it is good to see these efforts being tried again, I am skeptical that much real value will come from them,” Mr. Nahra said.