Compliance and the Quality of Care Revolution: Fitting the Pieces Together in the Government's New Enforcement Landscape

With increasing frequency, government regulators have used the False Claims Act (FCA) and other federal and state fraud statutes to crack down on healthcare providers, including hospitals, for providing poor quality of care or unnecessary services. The past few years have seen several civil and criminal enforcement actions, many resulting in multi-million dollar settlements, prison sentences, and exclusion from federal healthcare programs. In response to this enforcement activity, the Office of Inspector General (OIG) and the American Health Lawyers Association (AHLA) jointly published a white paper, Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors. The report recognized that government quality enforcement has reached a new watermark of activity. In order to fulfill their fiduciary duties, boards of directors must make serious and immediate efforts to understand their healthcare organization’s ability to monitor and provide sufficient quality of care.

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