Worthless Services: What They Are, Why They Matter, and How to Monitor in Your Organization

• November 10, 2023

• Elliott Coward , Morris Manning & Martin LLP
• Jerry Williamson, M.D.,FAAP., MJ., CHC., LHRM , Loyola University Chicago School of Law

Organizational expenses are typically in the jurisdiction of management or finance teams, while patient safety events are usually addressed by the risk management department or by internal peer review processes. But when should cost-cutting measures or adverse events be forwarded to the compliance or legal departments as well? Recent Department of Justice (DOJ) enforcement actions suggest that quality issues are not reserved for risk management or the Joint Commission. Systemic issues should be evaluated by Compliance and Legal to determine whether False Claims Act (FCA) concerns are also present. From a physician’s perspective, this is an important reminder: physicians often have malpractice risk at top of mind, but many physicians may not be aware of the worthless services doctrine or that they can face FCA liability that would overlap with malpractice liability.

ARTICLE TAGS

• Fraud & Abuse Practice Group
• Fraud and Compliance