A new “Fraud Risk Indicator” from the HHS Office of Inspector General will draw attention to health care organizations that settled False Claims Act cases but refused to enter into corporate integrity agreements (CIAs). The Fraud Risk Indicator, posted on OIG’s website Sept. 27, has five categories of risk, from low to highest, that describe the degree of danger that organizations are thought to pose to federal health care programs. They mirror OIG’s 2016 risk spectrum for applying its permissive exclusion authority (RMC 4/25/16, p. 1).
“Our goals are more transparency and to be more user friendly consistent with the risk spectrum,” said Gregory Demske, chief counsel to the Inspector General, at the American Health Lawyers Association’s Fraud and Compliance Forum in Baltimore. Right now, when looking at a civil settlement that doesn’t exclude the defendant from federal health care programs, “it isn’t clear” to the public and other organizations “if we think they are relatively low risk or high risk,” he said. “Going forward, that will be information that’s available.”