Fraud Management & Cybercrime , Fraud Risk Management , Healthcare

7 Tips for Complying With Healthcare Fraud Regulations

Attorney Rachel Rose on Navigating the Intensifying Scrutiny of Federal Regulators
Rachel Rose, regulatory attorney

Over the past two years, federal regulators have intensified their scrutiny of the healthcare sector, and they're cracking down on fraud in all forms including kickbacks, lapses in cybersecurity and privacy, lack of fairness in Medicare Advantage policies, and inflated pharmacy claims. Regulatory attorney Rachel Rose outlined seven key requirements for meeting numerous compliance mandates.

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Putting policies and procedures in place is not enough, Rose said. The compliance program must be comprehensive and properly implemented because the U.S. Department of Justice will verify its effectiveness beyond mere documentation.

"Do you have a compliance officer, regardless of the size of the organization?" Rose asked. "Are you training the staff across the board - both on HIPAA and cybersecurity and on fraud, waste and abuse laws?" Rose settled the first False Claims Act case under the DOJ's Civil Cyber-Fraud Initiative.

In this video interview with Information Security Media Group, Rose discussed:

  • Key compliance strategies for healthcare organizations;
  • The impact of technology on fraud enforcement;
  • Using data analytics to support compliance.

Rose is licensed in Texas. She is a fellow of the Federal Bar Association and serves as a director on the FBA's national board. She is a member of and the immediate past chair of the Federal Bar Association's Government Relations Committee and an advisory board member of its Qui Tam Section.

About the Author

Suparna Goswami

Suparna Goswami

Associate Editor, ISMG

Goswami has more than 10 years of experience in the field of journalism. She has covered a variety of beats including global macro economy, fintech, startups and other business trends. Before joining ISMG, she contributed for Forbes Asia, where she wrote about the Indian startup ecosystem. She has also worked with UK-based International Finance Magazine and leading Indian newspapers, such as DNA and Times of India.

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