The beginning of 2017 brought a new administration to the White House, along with some new and some familiar faces to executive agencies responsible for
regulation and oversight of the hospital sector.
Indeed, many positions in these agencies are
still vacant or have only recently been filled.
2017 can thus be best categorized as a transition year, focused on forthcoming proposals
for the significant payment and regulatory
reform on the horizon in 2018.
Continued emphasis on
The Yates Memorandum,1 which was issued in
September 2015, notified the healthcare com-
munity that there would be an increased focus
on individual wrongdoers by the
U.S. Department of Justice (DOJ).
The Trump Administration
has not wavered from this message. Deputy Attorney General
Rod Rosenstein repeatedly has
emphasized that DOJ will continue
to investigate and prosecute those
persons responsible for significant corporate misconduct. Acting
Assistant Attorney General Kenneth
A. Blanco recently noted that False
Claims Act (FCA) settlements and
DOJ “indictments should send a
clear signal to hospitals and healthcare institutions around the country
that they and their management will
be held accountable.” 2
One example of the Yates
Memorandum in action was the
April 2017 settlement by Norman
Regional Health System, which
involved a former hospital administrator and six physicians. The
defendants were alleged to have
improperly billed Medicare for
by Arthur J. Fried, Melissa L. Jampol, and Chelsea E. Ott
Enforcement and regulatory
concerns for hospitals in 2018
» Hospitals must be prepared to respond to a changing regulatory and enforcement environment in 2018, especially with
respect to electronic health records (EHR), billing and coding, and OPPS and IPPS.
» Hospitals need to ensure that they have effective processes in place for employees to make complaints as well as to ensure
that the complaints are thoroughly investigated and resolved objectively and decisively.
» With a continued emphasis by regulators on improper billing, hospitals should implement effective controls and monitor and
audit their billing and provider arrangements to prevent improper billing, particularly of federal healthcare programs.
» In the event hospitals discover potential overpayments, they should seriously evaluate the repayment and self‑disclosure
requirements of federal and state law.
» Hospitals are training providers on the technical infrastructure, effective use of the EHR, and regulatory incentives, but they
must be wary that an EHR system itself can cause false claims, or lead to false claims, if not properly implemented.
Arthur J. Fried ( email@example.com) is a Member of the firm in the Health Care
and Life Sciences practice in the New York office of Epstein Becker & Green, PC.
Melissa L. Jampol ( firstname.lastname@example.org) is a Member of the firm in the Health
Care and Life Sciences and Litigation practices in the New York and Newark offices
of Epstein Becker & Green, PC. Chelsea E. Ott ( email@example.com) is a Law Clerk
– Admission Pending at Epstein Becker & Green, PC in the Health Care and Life
Sciences practice in the New York office.
/in/arthurjfried /in/jampol bit.ly/in-ChelseaOtt