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Government Health Care Law Regulation White Collar Crime

Don’t Set It & Forget It: The Importance of Evaluating & Evolving Healthcare Compliance Programs

The federal government won or negotiated over $2.6 billion in healthcare fraud judgments and settlements in 2019. The government’s investment of resources toward combatting fraud, waste and abuse in healthcare can be expected to continue in full force, irrespective of a change in political administration. Accordingly, it is important for healthcare companies to focus on maintaining flexible and effective compliance programs.


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On June 1, 2020, the Department of Justice (DOJ) released an updated version of its “Evaluation of Corporate Compliance Programs” guidelines for prosecutors to apply in assessing compliance program effectiveness in the context of resolving criminal investigations of companies (the DOJ Guidance). The latest revisions to the DOJ Guidance — originally published by the DOJ’s Criminal Division in February 2017 and updated in April 2019 — are not voluminous. Nonetheless, the changes reflect a continued and concerted emphasis by DOJ on the robustness of a company’s processes for reevaluation and, as necessary, evolution of the organization’s compliance program to ensure it is not only in place, but working effectively. Parallels to the prominence of measuring and testing compliance programs found in the DOJ Guidance for criminal prosecutions can be found in the practice and policies of the Office of Counsel to the Inspector General for the U.S. Department of Health & Human Services (HHS-OIG), which investigates civil, criminal, and administrative violations of the healthcare laws, often in conjunction with the DOJ.

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