Categories
Corruption, Crime and Compliance

Healthcare Compliance and Fraud

In this eye-opening episode of Corruption, Crime and Compliance, Michael Volkov takes a deep dive into the world of healthcare compliance and fraud. He explores the history, the transformation, and the unique challenges of healthcare compliance. He also sheds light on the alarming rate of fraud in the healthcare industry and the efforts to combat it.

You’ll hear him discuss:

  • Compliance in healthcare traces back to the 1990s. Its rise is largely due to aggressive federal enforcement programs and increasing regulation.
  • Four significant trends in healthcare compliance include: 
    • Rising consumer demand, escalating prices, and increasing regulation during the era of HMO controversies.
    • The DOJ’s use of criminal tools and prosecutions to combat healthcare fraud and circumvent government regulations.
    • The growing importance of the False Claims Act as an enforcement tool.
    • The establishment of a robust regulatory enforcement regime through the Center for Medicare Services and the HHS-OIG.
  • As the healthcare industry comes increasingly under federal government regulation and control, the risks of healthcare fraud are escalating. Despite the development of proactive compliance programs, the industry struggles to keep pace with the level of fraud, waste, and abuse.
  • Beyond the traditional elements of compliance programs, the healthcare industry faces unique challenges. These include managing interactions with physicians, ensuring data privacy, avoiding the employment of ineligible persons, and navigating the complexities of billing, coding, and overpayments.
  • The False Claims Act poses a significant risk for healthcare providers, with nearly 99% of all cases each year immediately settled. The Act has been applied beyond billing and reimbursement issues to include false representations incorporated into a product or a drug.
  • The DOJ regularly conducts nationwide crackdowns on healthcare fraud, arresting numerous defendants involved in healthcare fraud and opioid abuse schemes. A growing area of concern is telemedicine fraud, which has seen a surge with the rise of remote work during the pandemic.

 

KEY QUOTES:

“Healthcare is becoming increasingly under federal government regulation and control. And as this occurs, the federal healthcare risks of fraud are going to be increasing significantly. Private insurance companies are also experiencing continuous growth of fraud and the healthcare industry is really developing proactive compliance programs, but they struggle to keep up with the level of fraud, waste, and abuse that they sort of have to pursue.” – Michael Volkov

 

“…one of the most significant risk areas is physician interactions.” – Michael Vokov

 

“Nearly 99% of all False Claims Act cases each year where the government decides to intervene are immediately settled.” – Michael Volkov

 

Resources

Michael Volkov on LinkedIn | Twitter

The Volkov Law Group

Categories
Daily Compliance News

Daily Compliance News: July 10, 2023 – The Meta, Threads and Anti-trust Edition

Welcome to the Daily Compliance News. Each day, Tom Fox, the Voice of Compliance brings to you compliance-related stories to start your day. Sit back, enjoy a cup of morning coffee, and listen in to the Daily Compliance News. All, from the Compliance Podcast Network. Each day we consider four stories from the business world, compliance, ethics, risk management, leadership, or general interest for the compliance professional.

  • Labor Party to back global ABC court. (The Guardian)
  • Chinese ABC probe moves to an advanced stage. (FT)
  • Did a sheriff’s corruption lead to a mass shooting? (Houston Chronicle)
  • Meta, Threads, and anti-trust. (NYT)
Categories
All Things Investigations

All Things Investigations: Episode 30 – The Convergence of ABC, AML and Export Controls with Mike Huneke and Jan Dunin-Wasowicz

Mike Huneke and Jan Dunin-Wasowicz join Tom Fox on this episode of All Things Investigation, to shed light on key ideas and challenges faced by companies and compliance professionals in the evolving landscape of trade sanctions and anti-corruption compliance. They explore the shift from traditional know-your-customer (KYC) practices to a more comprehensive anti-corruption mindset, the impact of sanctions on various sectors in Europe as well as the convergence of anti-evasion practices. Focusing on the recent emphasis on trade sanctions and their impact on global business, Mike and Jan offer valuable insights and practical guidance for companies navigating these complex regulatory landscapes.

Mike Huneke and Jan Dunin-Wasowicz are partners at Hughes Hubbard and Reed. They are both anti-corruption lawyers with a passion for bridging the gap between ABC and trade sanctions compliance. Mike and Jan provide valuable expertise to companies seeking to align their risk management strategies with the evolving regulatory landscape.

You’ll hear Tom, Mike and Jan discuss:

  • The impact of the Russian invasion of Ukraine and the subsequent trade sanctions imposed by the US and Europe.
  • Companies need to move beyond traditional KYC analysis and adopt an anti-corruption mindset when dealing with trade sanctions compliance. Mike emphasizes that this shift requires companies to proactively identify and address high-risk countries, red flags, and evasion techniques.
  • The challenges posed by sophisticated evasion schemes and the importance of adopting a holistic approach that combines the expertise of anticorruption and export controls teams.
  • A new geography of sanctions risks has emerged, with companies having to navigate potential risks not only directly linked to Russia but also arising from the global ripple effects. It’s therefore important to incorporate a dynamic and flexible framework that can adapt to changing geopolitical dynamics and future risks beyond the current focus on Russia.
  • Jan points out that with the imposition of Russian sanctions, entire segments of the European economy are affected by controls and measures. This extends beyond financial institutions and requires operators in different sectors to learn about and navigate sanctions compliance, leading to a steep learning curve.
  • In-house compliance departments need to address trade sanctions risks, with a focus on collaboration between anti-corruption and export controls teams to identify and address the highest risks of evasion.
  • The convergence of anti-corruption and trade sanctions compliance: The focus is on combating evasion techniques, such as the use of third parties and assessing risks to prevent bribery and sanctions violations.
  • Compliance professionals and companies face increasing pressure and find themselves in complex situations. The goal is to develop frameworks and methods that help professionals navigate and operate in a world that is becoming more complicated by the day.

 

KEY QUOTES:

“KYC is dead, and you have to apply an anti-corruption mindset to trade sanctions compliance.” – Mike Huneke

“If those two teams work together, I think you can identify very defensible and well-documented ways to identify what are the highest risks of evasion and then taking that skepticism and maybe paranoia that we develop in the anticorruption space and applying it to those select transactions.” – Mike Huneke

“Two-thirds of the world population live in countries that haven’t imposed sanctions on Russia or simply don’t really care for the sanctions in Russia.” – Jan Dunin-Wasowicz

“The goal here, really, in this exercise is to formulate a framework, formulate a method to look at this problem, to make the life of an in-house lawyer compliance professional a little easier.” – Jan Dunin-Wasowicz 

 

Resources:

Hughes Hubbard & Reed website

Mike Huneke on LinkedIn

Jan Dunin-Wasowicz on LinkedIn

Categories
Sunday Book Review

Sunday Book Review: July 9, 2023 – The Summer Mysteries Edition

In the Sunday Book Review, I consider books that would interest the compliance professional, the business executive or anyone who might be curious. It could be books about business, compliance, history, leadership, current events or anything else that might interest me. In today’s edition of the Sunday Book Review, now that summer is fully upon us, we look at mysteries set in the summer.

  • The Murder of Mr. Wickham by Claudia Gray
  • Dead Dead Grils by Nekesa Afia
  • Treachery on 10th Street by Kate Belli
  • Secret Identity by Alex Segura
  • The House on Vesper Sands by Paraic O’Donnell

Resources

Historical Mystery Reads For When Summer is Calling Your Name by Kate Karvari in CrimeReads.com

Categories
Because That's What Heroes Do

Firefly – Episode 12, The Message: The War’s Unwanted Soldier

Megan and I go in a different direction for our next sci-fi series as we take up the 2002 series Firefly. The show is an American space Western drama television series. The series is set in the year 2517, after the arrival of humans in a new star system, and follows the adventures of the renegade crew of Serenity, a “Firefly-class” spaceship. The ensemble cast portrays the nine characters who live on Serenity. Join the dynamic and delightful hosts Tom Fox and Megan Dougherty as they dive into the latest episode of Firefly in their podcast, Because That’s What Heroes Do!

The episode of Firefly discussed by Tom Fox and Megan Dougherty featured a 30s carnival-themed episode with a poignant line, “you murdered yourself. I just carried the bullet a while”. The crew of Serenity had to decide whether or not to trust their old war buddy, Tracy, who was too young to be a soldier and was irreparably damaged by a war he never should have been in. Preacher’s intelligence and experience was highlighted as he negotiated with the people they encountered, using guns pointed at Jane, Zoe, and Mal as leverage. Simon’s incompetence when it comes to interacting with women was also discussed, as well as Jane’s ability to notice things. The episode concluded with Tracy being buried on his own planet in a snowstorm.

Highlights

·      Shepherd Book’s Negotiation

·      Tracy’s Tragic Death

·      Jane’s Fuzzy Hat

·      Smuggling Organs

 Resources

Megan Dougherty 

LinkedIn

One Stone Creative

Twitter

Tom 

Instagram

Facebook

YouTube

Twitter

LinkedIn

Categories
10 For 10

10 For 10: Top Compliance Stories For the Week Ending July 8, 2023

Welcome to 10 For 10, the podcast which brings you the week’s Top 10 compliance stories in one podcast each week. Tom Fox, the Voice of Compliance brings to you, the compliance professional, the compliance stories you need to be aware of to end your busy week. Sit back, and in 10 minutes hear about the stories every compliance professional should be aware of from the prior week. Every Saturday, 10 For 10 highlights the most important news, insights, and analysis for the compliance professional, all curated by the Voice of Compliance, Tom Fox. Get your weekly filling of compliance stories with 10 for 10, a podcast produced by the Compliance Podcast Network.

  • Unilever adds its name. (RFE)
  • Pakistan makes over-night changes in ABC law. (Business Insider)
  • More on CA Supreme Court expansion of whistleblower protection. (Law360)
  • Are banks too big to manage? (WSJ)
  • SEC charges window maker and its ex-CFO over accounting violations. (Reuters)
  • Corruption still bedevils Lebanon. (PBS)
  • Twitter threatens Meta over Threads. (Reuters)
  • Is Ivy League morally bankrupt? (FT)
  • Cop now in charge of SFO. (WSJ)
  • Top Lazard banker fired for harassment. (WSJ)

You can check out the Daily Compliance News for four curated compliance and ethics related stories each day, here.

Connect with Tom 

Instagram

Facebook

YouTube

Twitter

LinkedIn

Categories
Creativity and Compliance

Creativity and Compliance – Creativity in Training and Communications at Starbucks

Where does creativity fit into compliance? In more places than you think. Problem-solving, accountability, communication, and connection – all take creativity. Join Tom Fox and Ronnie Feldman on Creativity and Compliance, part of the award-winning Compliance Podcast Network.

Ronnie’s company, Learnings and Entertainment, utilizes the entertainment devices that people use to consume information in their everyday, non-work lives, and apply it to essential topics around compliance and ethics. It is not only about being funny. It is about changing the tone of your compliance communications and messaging to make your compliance program, policies, and resources more accessible. Today Ronnie and Tom are joined by Len Larsen, Manager, Ethics and Compliance, and Cory Macdonald, Learning Manager, Ethics and Compliance. Both are at Starbucks in Ethics and Compliance.

The Ackerman principle of innovate, elevate, and educate was the focus of the conversation between Len & Cory and Tom & Ronnie, on the importance of addressing microaggressions in the workplace. They discussed the need for managers to have the necessary soft skills to have difficult conversations and create a speak-up culture in the workplace. They also discussed the importance of intent versus impact, the need for trust between managers and their employees, and the need for companies to provide role-playing and other training to help managers learn how to have difficult conversations. Finally, they discussed the need for companies to be comfortable with the discomfort of trying something new and be willing to pivot if it doesn’t work out.

Key Highlights

·      Soft Skills Training

·      Managing Difficult Conversations

·      Manager Behavior

·      Innovate, Elevate, Educate

·      Microaggressions in Workplace

·      Coaching First-Time Employees

·      Speaking Up

Resources:

Ronnie

Tom

Instagram

Facebook

YouTube

Twitter

LinkedIn

Categories
Because That's What Heroes Do

Firefly – Episode 11, Trash: A Heist, a Con, and Love

Megan and I go in a different direction for our next sci-fi series as we take up the 2002 series Firefly. The show is an American space Western drama television series. The series is set in the year 2517, after the arrival of humans in a new star system, and follows the adventures of the renegade crew of Serenity, a “Firefly-class” spaceship. The ensemble cast portrays the nine characters who live on Serenity. Join the dynamic and delightful hosts Tom Fox and Megan Dougherty as they dive into the latest episode of Firefly in their podcast, Because That’s What Heroes Do!

Beginning with the captivating detail that River’s line “I could kill you with my brain” is the best line in the episode, this podcast episode discussed the TV show “Firefly” which involved a heist, a con, and a deepening relationship between Mal and Inara. Tom and Megan discussed the importance of having an intimacy coordinator and union rules for nude scenes, as well as the difference between when men and women do nude scenes. They also discussed the dialogue between Simon and Jane, and the plan to dump the gun in a trash chute and intercept the trash being removed. The conversation then shifted to the current world climate, and the importance of having an intimacy coordinator and union rules for such scenes. Finally, they discussed Mal’s feelings for Inara and how they may not be brotherly. 

Highlights

·      Saffron’s Heist Plan

·      Nudity

·      Saffron’s Con

·      Heist on Water Planet

·      Jayne, Simon & River

 Resources

Megan Dougherty 

LinkedIn

One Stone Creative

Twitter

Tom 

Instagram

Facebook

YouTube

Twitter

LinkedIn

Categories
Kerrville Weekly News Roundup

Kerrville Weekly News Roundup: July 8, 2023

Welcome to the Kerrville Weekly News Roundup. Each week, veteran podcaster Tom Fox and his colleagues Andrew Gay and Gilbert Paiz get together to go over a couple of their favorite stories from the past week from Kerrville and the greater Hill Country. Sit back, enjoy a cup of morning coffee and listen in to get a wrap up of the Kerrville Weekly News. We each consider two of our favorite stories and talk about the upcoming weekend’s events which will enjoy or participate in this weekend.

In this episode, Tom and Andrew discuss the following stories which caught their attention over the past week.

·      Tom shouts out to Margot Newcomb for being honored by Morgan’s Wonderland Theme Park for her work in handicap accessibility. He also shouts out to the Schreiner University School of Nursing which had a 100% pass rate on National Licensure exam. Tom encourages listeners to visit the final weekend of the 40th anniversary celebration at the Museum of Western Art.

·      Andrew discusses the 4th of July Concert on the River this year which featured the Randy Rogers Band. He also talks about the Cailloux preview party for the 2023-24 arts season in Kerrville. Andrew shouts out The Lead for its photos from the event.

·      Andrew and Tom welcome the break in temperature for the weekend.

Resources

Tom Fox on LinkedIn

Gilbert Paiz on LinkedIn

Andrew Gay on LinkedIn

Texas Hill Country Podcast Network

Categories
Report from IMPACT 2023

Report from IMPACT 2023 – Andrew Weissmann – Compliance Rules from the DOJ Perspective

ECI’s IMPACT 2023 was one of the leading compliance events in 2023. At this conference, Tom Fox, the Voice of Compliance, was able to visit with several of the speakers, exhibitors, participants, and one group of ethically-minded Girl Scout Troop. In this limited podcast series, Report from IMPACT 2023, Tom explores many of the most cutting-edge topics in ethics and compliance through short podcast episodes. Check out the full series of interviews. You will be enlightened, informed and come away with a fuller and more thorough understanding of the most cutting-edge topics in ethics and compliance. In this episode, Tom visits Andrew Weissmann, former head of the DOJ Fraud Section and current Podcaster and author.

The Department of Justice has been working to ensure that companies understand the rules of the road and what is expected of them to comply with the law. Tom Fox and Andrew Weissmann discussed the evolution of compliance programs from the Department of Justice’s perspective, the dialogue between the Department of Justice and the compliance community, the FCPA Pilot Program, the ABB FCPA Enforcement Action, and the need to use different forms of media to ensure that people are consuming the right information. They highlighted the importance of self-disclosure, extraordinary cooperation, and extraordinary remediation to receive a stunning result from the Department of Justice. Furthermore, they discussed the need to educate people in a variety of ways, such as Twitter, podcasts, articles, and op-eds, to ensure that policies are read and consumed. This podcast episode provides an insightful look into the Department of Justice’s approach to compliance and the need for different forms of media to ensure that people are informed.

Highlights include 

·      Compliance Evolution

·      Compliance Education

·      FCPA Recidivism

Resources 

Andrew Weissmann

Prosecuting Donald Trump podcast

Connect with Tom Fox on Linkedin

ECI