Health Care Committee

ABI Committee News

In Such a Regulated Industry, Why So Much Fraud and Financial Impropriety?

SAK Management Services LLC; Northfield, Ill.

Nancy A. Peterman
Greenberg Traurig LLP; Chicago
Elizabeth Sickelka [1]
Greenberg Traurig LLP; Chicago

The health care industry is one of the most regulated industries with extensive federal and state governmental oversight. For instance, the industry is largely financed by monies paid under the Medicaid and Medicare programs, which require health care facilities receiving these monies to submit cost reports to federal and state governments that substantiate the monies received. The agencies regulating these facilities also have the ability to audit the facilities’ cost reports and obtain, as part of that audit, additional detailed financial information from the health care facilities—thus, the facilities’ finances are monitored and can be extensively reviewed. Moreover, state health departments are to survey and carefully monitor health care facilities to ensure that quality care is being provided, and those facilities can be fined or even lose their licenses for serious patient-care issues. Finally, as most health care facilities are licensed by state health departments, an extensive investigation is typically required when the license is first granted or on any subsequent transfer, merger or the like. Again, this is a situation where the state government is supposed to be reviewing the facilities’ operations. With all this oversight, one would expect health care facilities to be well-run, transparent businesses.

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