The House health reform bill released on July 14 (America's Affordable Health Choices Act of 2009 (HR 3200)) continues the steady drum beat of Congressional and Obama Administration efforts to address fraud and abuse and achieve cost savings through enhanced enforcement resources and other compliance initiatives. House bill 3200 adds a further $100 million for integrity efforts and provides additional authority to the Health & Human Services Secretary to identify "significant risk areas" warranting further oversight to avoid fraud, waste and abuse. In addition, echoing a similar recent Medicaid program development in New York, the bill calls for the mandatory development and implementation of compliance programs by the majority of health care providers, excluding physicians, and would impose civil monetary penalties and the possibility of exclusion from participation in government health care programs on those who fail to comply. HR 3200 also would create and/or increase penalties for false claims and other actions by plans and providers.
Regardless of the form that the anticipated health care reform legislation ultimately takes, it seems abundantly clear that stepped up governmental enforcement efforts to redress fraud and abuse (real or perceived) will be an ongoing compliance and operational challenge for health care organizations to address.