Illegal referrals and inaccurate billing are often inadvertent, but can be part of deliberate and deceptive moneymaking schemes when physicians and other clinicians have ownership in outsourced providers for hospitals. Whether intentional or not, there is an ongoing pattern of regulatory compliance violations relating to the False Claims Act, the Stark Law, and the Anti-Kickback Statute. Headlines continue to regularly highlight fraudulent billing and illegal referrals that pose tremendous risk to hospitals, providers, and patients. Even alleged violations and pre-trial indictments can be costly given that regulatory agencies are authorized to suspend federal payments to providers under investigation.
On October 26, 2016, SpecialtyCare acquired Sentient, a highly regarded intraoperative neuromonitoring provider. We’re thrilled to welcome the people of Sentient to our team. We believe we’ll be a great fit together, both clinically and culturally. Combining our talent and experience will enhance our collective strengths and create new opportunities to advance patient care and drive clinical quality, which reduce costs for our patients and customers.
Estimates vary when calculating the money lost to fraud—it’s difficult to measure that which is undetected—but the Federal Bureau of Investigation (FBI) states that healthcare fraud costs the country tens of billions of dollars each year. Paying for law enforcement, legal resources, and sophisticated technology to combat the problem adds to the price tag. Taxpayers and employers endure the financial brunt of fraud, but illegal schemes can also put patient health at risk. Clearly, healthcare fraud is not a victimless crime.
The need for trust in healthcare is not limited to the clinical arena. Business practices matter, too. Wrongdoing on the business side often points to cultural shortcomings and a lack of integrity that can permeate the entire organization. As such, trust in a company’s underlying culture is as important as trust in its clinical expertise or the efficacy of its services.