The DOJ's New Whistleblower Program: A Vital Step for Medical Coding Compliance

The DOJ’s New Whistleblower Program: A Vital Step for Medical Coding Compliance

On August 1, 2024, the U.S. Department of Justice (DOJ) launched its Corporate Whistleblower Awards Pilot Program. This initiative is a significant development in the DOJ’s efforts to uncover corporate misconduct, particularly in areas not covered by existing whistleblower programs like those of the SEC or CFTC. The program incentivizes individuals to report original information about corporate wrongdoing, offering monetary rewards for tips that lead to successful prosecutions and asset forfeitures.

Implications for Medical Coding Compliance

For the medical coding industry, this new program holds particular relevance. Historically, whistleblower incentives have focused on fraud against federal programs such as Medicare and Medicaid under the False Claims Act. However, the new DOJ program extends potential rewards to those reporting fraud involving private insurers and other non-public health care benefit programs. This fills a crucial gap, as such cases were previously outside the scope of qui tam actions.

Key Features and Benefits

Monetary Incentives: Whistleblowers can receive a portion of the financial penalties imposed, with awards reaching up to 30% of the first $100 million forfeited. This substantial incentive is designed to encourage more insiders to come forward with valuable information.
Broader Scope: The program addresses a wider range of corporate misconduct, including domestic and foreign corruption schemes and healthcare fraud. By including private insurance fraud, it provides a new avenue for addressing unethical practices in medical coding and billing that might otherwise go unreported.
Confidentiality and Protection: The DOJ emphasizes the confidentiality of whistleblowers and warns against retaliatory actions, underscoring the seriousness of protecting those who expose wrongdoing.

Importance for the Medical Coding Community

Medical coders and healthcare compliance professionals should take note of this program as it underscores the importance of maintaining ethical standards. The potential for financial reward, coupled with the assurance of confidentiality, may encourage more individuals to report discrepancies or fraudulent activities they encounter. This is especially pertinent as the DOJ aims to deter companies from neglecting internal compliance in favor of profit.

Conclusion

The DOJ’s Corporate Whistleblower Awards Pilot Program represents a significant advancement in the fight against corporate crime, with direct implications for medical coding compliance. It not only broadens the scope of reportable misconduct but also strengthens the tools available to hold wrongdoers accountable, thereby promoting greater integrity within the healthcare industry.

For more information, visit the Reuters News Article.

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By Mark Babst|2024-08-10T04:58:10+00:00August 8th, 2024|

About the Author: Mark Babst

BA, Rutgers University ‘69 MPA, Syracuse University ‘71 Mark entered the medical field as a Program and Budget Analyst with New York City’s Health and Hospitals Corporation. After gaining experience in the public sector, he spent a number of years working for non-profit as well as private-sector healthcare delivery systems.Mark met Neal in 1976 when he moved from Boston to Los Angeles after a particularly nasty winter. Both had enrolled in a UCLA Extension class on what was then an entirely new topic: computer applications in the business of medicine. In 1980, Mark began his academic faculty practice experience as the Deputy Director and Chief Revenue Officer for UCLA’s Department of Medicine. Three years later, he was recruited to be the first Executive Director of the 112 physician Children’s Hospital of Los Angeles Medical Group, an affiliate of the University of Southern California. During his tenure, Mark helped double collections and lay a stable financial and organizational foundation for growth.In 1986, Mark joined Neal Green at Medi-Sec, Inc. as the Executive Vice President. The 9 years working with Neal in the medical billing industry and his discovery of the marketplace need for a specialty-specific coding service led Mark to help create The Coding Network in 1995. For 24 years Mark has been helping fill this need with top quality coding services, helping hundreds of clients and many thousands of physicians optimize their revenue streams and minimize their compliance exposure. As business partners with over 75 years of experience, Mark and Neal are well versed in the unique revenue cycle needs of physicians and have structured The Coding Network to excel in this arcane but essential niche.