The FBI was tipped off to the college admission scandal by a trader who was being investigated for insider trading.
He hoped by dropping a dime on someone, anyone he would gain favorable treatment.
The storm he touched off pretty much guarantees those convicted will find no mercy.
Who inside your organization knows about inappropriate data submission?
What would happen to them if they were arrested? Would you be vulnerable?
CMS has essentially stopped assessing civil fines on Medicare Advantage Organizations for false data submission. This creates an environment that encourages fraud.
And just as lax enforcement in the Higher Education space created the preconditions for the recent arrests, so it will be in Medicare Advantage.
There’s certain to be some whistleblower out there who will uncover massive fraud. And like the higher education scandal, it won’t be the politically protected large organizations who’ll be hit, it’ll be the little guy.
Will you and your organization be the object of the next viral prosecution? Or will your organization’s “culture of compliance” protect you?
When was the last time your CEO pressed the flesh with your coding and compliance rank and file?
When was the last time you had an independent chart audit performed?
Given the lack of compliance enforcement, a Medicare Advantage scandal is going to happen.
The only question is, will you be the face of it?