Compliance Update

As the Trump Administration takes over in Washington, many healthcare attorneys, administrators and compliance officers are attempting to discern what issues may be impacted by President Trump’s initiatives. While the jury is still out on what final changes will occur, one can glean some of the potential changes based on the Trump campaign rhetoric, outcry from the provider world and trends of current initiatives.

First, it is unlikely that a Trump Administration will have a significant impact on fraud and abuse investigative efforts including False Claims Actions. False Claims are primarily brought Qui Tam through third party relators. With the sophistication of the Qui-Tam Bar growing, it is likely that these types of actions will continue. Following the trend of the Obama Administration, False Claims Actions are likely to continue to increase. These actions have risen by approximately 1,500 during President Obama’s term and equated to a 60% increase in financial recoveries compared to the Bush Administration. The Department of Justice will continue to pursue what they perceive as legitimate actions as they are brought to them by Qui-Tam relators in addition to those cases that they move forward with by themselves. There is no indication that this type of enforcement activity will slow down.

Further, all indications of DHHS Secretary Nominee Dr. Tom Price are that we will continue to move towards value-based payment systems. Systems such as the Comprehensive Joint Replacement initiative that are already underway will likely go on uninterrupted. Additionally, new programs such as the Cardiology Episode Payment Model are likely to move forward as well. Existing payment models such as Provider-Based Reimbursement continue to be scrutinized by the OIG as indicated in their effort stated in the 2017 DHHS OIG Work Plan to compare provider-based payments to freestanding clinic payments. Reimbursement as we know it is likely to continue to change under the Trump Administration.

While new initiatives will continue to be introduced, some existing items introduced through ACA are likely to be replaced. Candidates for replacement are the 2.3% medical device tax which President Trump spoke against during his campaign and the Medicare overpayment final rule, otherwise known as the 60-day rule. This initiative has come under harsh criticism from providers during its long implementation period.

While it would take a crystal ball to know exactly what changes will take place under the Trump Administration, there is some information available that provides strong indications of the direction we may be headed. We will continue to monitor these changes and provide you with information as it becomes available in the future.