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Category Archives: Reform

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A Compliance Officer’s Wish List for 2012

By Frank Sheeder on Posted in Culture, Enforcement, Ethics, Government Initiatives, Reform

I was visiting with some of my compliance colleagues recently and came up with an interesting Wish List for 2012:  Additional resources. Clearer regulations :) Increased stakeholder support for compliance activities. More predictable and quicker voluntary disclosure processes. A better way to keep track of regulatory developments and new business arrangements. Acknowledgement by regulators and enforcers… Continue Reading

12 Enforcement and Compliance Predictions for 2012

By Frank Sheeder on Posted in Culture, DOJ, Enforcement, Government Initiatives, ICD, Implantable Cardiac Devices, Long Term Care, Medicaid, Medicare, OIG, Reform, Settlements

This has been an interesting year for the health care industry, and I believe the coming year will be even more exhilarating.  Here are my 12 enforcement and compliance predictions for 2012.  Please comment with yours.  We’ll see how we do. . . .   Regardless of what happens with the health care reform law, the current market forces… Continue Reading

A 10-Year Old’s View of Health Care Enforcement

By Frank Sheeder on Posted in DOJ, Enforcement, Fraud, Medicaid, Medicare, OIG, Reform

My Daughter’s Depiction of Health Care Enforcement — I Call it Enforcica  — One of the more challenging and rewarding aspects of being a health care attorney is taking a complex regulated environment and breaking it down in a way that is understandable, regardless of the audience.  In the compliance world, this means communicating the rules… Continue Reading

Medicaid RACs Will Soon Spring to Life: Another Head Grows on the Hydra of Government Oversight and Inquiry

By Frank Sheeder on Posted in Government Initiatives, Medicaid, RACs, Reform

Here is a good summary of the new Medicaid RAC regulations.  Thanks to my colleague Becca McKnight for putting it together.  The original appears on DLA Piper’s Health Care Law Matters Blog. Contributed by Frank E. Sheeder III and Rebecca Jones McKnight as part of our ongoing Fraud & Abuse Matter series. Health care providers may… Continue Reading

HHS Redoubles its Data Prospecting Efforts

By Frank Sheeder on Posted in CMS, Enforcement, False Claims Act, Government Initiatives, ICD, Implantable Cardiac Devices, Medicare, OIG, Reform

In previous posts, I have mentioned the government’s “data prospecting” efforts, and highlighted the difference between “data mining” and “data prospecting.”  Mining is done when you already know where to dig.  Prospecting, which is what the government has been doing, involves finding out where to dig.  There’s a big difference, and the implications should not… Continue Reading

View the OIG HEAT Provider Compliance Training Webcast

By Frank Sheeder on Posted in Administration, Enforcement, False Claims Act, Fraud, Government Initiatives, Medicaid, Medicare, OIG, Reform

OIG has posted a webcast of its HEAT Provider Compliance Training.  It is 3 hours, 45 minutes long.  I will post a summary in the near future.  There is also an OIG HEAT Provider Compliance Training Website at which you can download the corresponding slides and related materials. Get Instant Updates by Email

Ronald Reagan Speaks Out Against Socialized Medicine

By Frank Sheeder on Posted in Administration, Government Initiatives, Reform

I came across this 1961 recording of then-private citizen Ronald Reagan speaking out against the threat of socialized medicine.  This wasn’t the first time these issues came up.  In the 1940′s, there was a similar debate when Harry S. Truman endeavored to create a national health insurance system.  It is intriguing that the debate about government’s role… Continue Reading

The More Things Change — Parallels Between Clinton and Obama’s Messages

By Frank Sheeder on Posted in Administration, Enforcement, Government Initiatives, OIG, Reform

I was doing some research and came across something interesting.  In September 1993, there were news articles across the country like:  “Clinton Positioned to Crack Down on Fraud if Health Care Plan Passes.”  In March 2010, there were articles to the effect:  “Obama Gets Tough on Health Care Fraud.”  Just this week, we have two… Continue Reading

Healthcare Compliance – What every Senior Leader Needs to Know in 2011

By Frank Sheeder on Posted in Culture, Enforcement, Government Initiatives, OIG, Reform

I recently participated in a webinar hosted by EthicsPoint called Healthcare Compliance – What every Senior Leader Needs to Know in 2011. Here’s some background on it: The healthcare industry is currently faced with mounting economic, political and regulatory pressures. State and local governments have increased their enforcement budgets in an effort to gain prompt… Continue Reading