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The government's health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in 2011, the highest annual amount ever recovered.
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Healthcare providers have been subject to the volatility of the insurance market for years, which has led some to look to the idea of establishing a captive as a way to cut costs, particularly with workers' compensation coverage. A captive can be a great solution in some circumstances, but don't jump without looking first.
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Healthcare leaders have to worry about complying with plenty of industry-specific requirements and the potential cost when a whistleblower reports malfeasance. Another risk, however, comes from the broader world of corporate fraud.
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Captive insurance agencies require the insured to take on more claims risk, but that risk is not unlimited. Even with a captive, you don't risk paying entirely out of pocket for a major claim or repeated claims in one year, says Christopher M. Keith, a producer with The Graham Co. in Philadelphia.
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Why should a patient's electronic health record (EHR) be stored on-site, when the records can be cost effectively stored on the Internet at a remote location? This question is posed by Bernard Rosof, MD, MACP, CEO of the Quality in Healthcare Advisory Group, a consulting firm in Huntington, NY.
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Health Management Associates (HMA) shareholders filed a class action in Florida federal court recently and claimed stock prices dropped after it was revealed the hospital group had used Medicare fraud to inflate prices and hidden a wrongful-termination whistleblower suit by an employee who uncovered the alleged fraud.
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Security is a major concern for healthcare providers using the cloud, says Paul Rubell, JD, partner in the Corporate Law Group at the law firm of Meltzer Lippe Goldstein & Breitstone in Mineola, NY.
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The Securities and Exchange Commission (SEC) Whistleblower Program was created in Section 922 of the Dodd-Frank Wall Street Reform and Consumer Protection Act of 2011.
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Captive insurance companies aren't for everyone, says Timothy E.J. Folk, vice president with The Graham Co., a healthcare consulting company in Philadelphia.
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There are about 5,000 captive insurance companies in the world, with most being sponsored by U.S. entities, according to information provided by Capstone Associated Services in Houston, TX, which assists organizations with setting up captives.
