MMM Partner Elliott Coward co-authored an article with Jerry Williamson, M.D., FAAP., MJ., CHC., LHRM for the American Health Law Association regarding the “worthless services” doctrine. This doctrine holds that a provider is in violation of the False Claims Act (FCA) if they submit a claim for services that are of such low quality that they are essentially equivalent to no services at all. FCA enforcement associated with inadequate care has been consistent over the past several years.
Alongside the government’s steady pursuit of FCA cases for misrepresented services, there is an increase in non-traditional healthcare corporate operation of healthcare providers leading to improved efficiency and lower costs. Coward and Williamson explain that “these cost controls must not affect quality, and it would be prudent for Compliance and Legal to have a place at the table when implementing such controls” and that “sometimes lower costs in the short term can cost much more in the long term.” Coward and Williamson state that providers and healthcare organizations will benefit if they “focus on health care quality and develop comprehensive quality improvement and patient safety programs in conjunction with an effective compliance program.”