Lauren Barnett, Compliance Content Specialist

Recently, Main Justice published an article (here) summarizing the sentiments expressed during a panel discussion (also hosted by Main Justice) with healthcare industry lawyers regarding healthcare fraud enforcement. Some of my favorite quotes from the article are as follows:

From Chris Wray of King Spalding in discussing how the cases have changed over time said, “As you start seeing those cases become more and more subtle, you’re going to see more and more litigation. [Prosecutors] have gotten better at pursuing these cases. They’ve gotten more aggressive and they’ve gotten more savvy about how the companies operate, what works and where the pressure points are.”

Ralph Hall of the University of Minnesota in discussion the threat of debarment said, “If you’re a publically traded company and you are excluded from participation in healthcare programs, that is essentially the death penalty…because of what happens to your stock if you disclose that the government may be pursuing exclusion? What this means is many of these legal theories have not really been challenged in court.”

My favorite quote came from Laurence Freedman of Patton Boggs LLP, “Something is wrong here. The goal should not be maximum recovery. I’m not sure we should be bragging about how many millions of dollars we’ve gotten from pharmaceutical companies.”

I wholeheartedly agree with what they said! The vagueness of the laws and the changing tide of enforcement make compliance difficult. It seems to me the goal here should be to work with companies to achieve compliance, not racking up huge settlements under the threat of exclusion. Where there has been fraud, absolutely go after it. But, the government has a mighty large hammer in exclusion. Perhaps that hammer should be used more as tool in enforcement rather than as a weapon.