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  4.  → Internal audit leads to concerning results: What if I find an AKS violation?

Internal audit leads to concerning results: What if I find an AKS violation?

Those who run healthcare facilities or private practices likely conduct regular internal audits to better ensure operations are in line with applicable regulations. Ideally, these audits will spot any potential issues before the rise to the level of a violation. On occasion, they may unearth some concerning information — potentially even evidence of a practice that was in violation of a statute.

What happens if we find a violation or questionable practice?

In a recent example, a Florida based hospital system realized that a past practice was likely a violation of the federal Anti-Kickback Statute (AKS). The AKS essentially makes it illegal for those who use federal healthcare programs like Medicare to knowingly and willfully pay or receive renumeration in return for referring an individual. The hospital system discovered a practice that provided discounts to Medicare beneficiaries as a way to encourage these patients to use their services.

The organization was concerned the discount essentially resulted in a financial benefit to the patients and was thus a violation of the FCA. Upon this discovery, the health system filed a timely self-disclosure and cooperated with the resulting investigation.

How does the government handle these matters?

In this example, the Department of Justice provided credit to the organization that aided in their ability to resolve the matter. The healthcare facility agreed to pay approximately $1.5 million to settle the matter. Due to their cooperation, the government has agreed to refrain from seeking action to exclude the organization from participation in federal healthcare programs or pursue criminal liability at this time.

Had the organization not taken prompt action, the consequences would likely have been much more dire. In this situation, there is a high likelihood that the healthcare system will be able to continue operations and rebound from this hurdle. The case serves as a reminder to conduct regular internal audits and take action to resolve any concerning findings.

Attorney John Rivas is responsible for this communication.