If you think the regulatory scrutiny of healthcare providers is intense now, just wait. It's only going to get hotter. That's the message from healthcare attorney and accountant Joanne Judge, who gave a late morning educational session today on legal issues on the final day of the Healthcare Financial Management Association's 2012 Annual National Institute in Las Vegas.
Specifically, Judge, who is a partner in Stevens & Lee's Reading, Pa., office, singled out fraud, antitrust and tax enforcement as the three areas providers should expect to see more action from federal and state regulators in the coming year.
A number of factors are driving the interest in fraud, according to Judge. First, data mining and other detection tools are becoming more sophisticated, making it easier for regulators to sniff out billing problems, she said. And given the huge return on investment, regulators are "just going to throw more money at it," Judge said.
Meanwhile, healthcare reform—whether formally through the Patient Protection and Affordable Care Act or informally through economic forces—is pushing providers together in many markets to coordinate care, and that only has increased the appetite of federal antitrust regulators to look at the competitive effects of those deals, Judge said.
“I see a ramping up on interest by agencies (Federal Trade Commission and U.S. Justice Department) in really drilling down into these transactions," she said. As an example, Judge cited a proposed acquisition of a 15-bed surgical hospital by a large hospital system in Pennsylvania that's been delayed because of an antitrust investigation by the FTC. Typically, a deal of that small size would go virtually unnoticed let alone investigated, she said.
Finally, the focus on tax-exempt organizations in healthcare "is just exploding," Judge said. What's attracting attention from state and federal regulators are community benefits, charity care, access to emergency services regardless of ability to pay and executive compensation, she said.
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