abl innovations presentation
TRANSCRIPT
Nick Merkin11845 W Olympic Blvd., Suite 1250Los Angeles, CA 90064 [email protected] www.compliagent.com
Healthcare Compliance Was Relatively Easy…HEALTHCARE FRAUD AND ABUSE CONTROL
PROGRAM
1997 - 2009$6.7 BILLION
2009 - 2013
$19.2 BILLION
Regulations Were Laxly Enforced.OIG ENFORCEMENT
BUDGET
2012$101 MILLION
2014
$389 MILLIONAN INCREASE OF OVER 1/3 IN JUST TWO YEARS
Healthcare Organizations Didn’t Invest Much on Internal Compliance Programming…
In Fact, Healthcare Providers Pretty Much Only Developed “Compliance Programs” If They Got Caught…
Healthcare Regulatory Violations, By and Large, Went Undetected or Had Little Consequence…FBI
PENDING CASELOAD
HEALTHCARE FRAUD
INVESTIGATION CASES
1992591 Cases
112 Agents
20133,542 Cases480
Agents1,023 Indictments
Providers Could Get Guidance
From Traditional Sources…
Healthcare Organizations Could Also Get Away With Building Little Infrastructure…
One Day, Things Changed…
Laws and Regulations Got More Strict…
Fines and Penalties Became More Intense…AVERAGE SENTENCING FOR
HEALTHCARE-RELATED CRIMES
52 Months In Prison
FOR EVERY DOLLAR SPENT ON HEALTHCARE-RELATED FRAUD AND
ABUSE INVESTIGATIONS BY THE FEDERAL GOVERNMENT IN THE
LAST THREE YEARS Government Recovered
$8.10
“Big Data” Made Regulatory Violations Easier to Spot…
Until Finally, The “Traditional” Professional Service Model Wasn’t Enough…
A New Professional Service Model Was Needed…
So What Do We Do?...
Access to Multiple Professionals With Varied Specialties Through a Single Point of Contact…
Lower Upfront Investment…
Quicker Adaptation to Regulatory Changes…
More Flexible
Use of Compliance Resources…
Third-Party Objectivity…
We Guide Providers and Help Them Develop Self-Perpetuating Infrastructure…
Improving the Bottom Line…
Sample Compliance Dashboard
…So They Can Focus On What They Do Best – Delivering The World’s Best Healthcare…
Nick Merkin11845 W Olympic Blvd., Suite 1250Los Angeles, CA 90064 [email protected] www.compliagent.com
Thank You For Your Time…
Questions?