This webinar will focus on cases and enforcement actions taken by the HHS OIG and its law enforcement partners in 2021.
We will also briefly review the Anti-Kickback Statute (“AKS”), discuss safe harbors, particularly the new proposed safe harbor for coordinated care and associated value-based arrangements, and OIG Advisory Opinions that have been issued in 2021, as well as pertinent cases involving the AKS.
This program is designed for healthcare executives, physicians, and other healthcare providers and their managers who participate in and receive remuneration from Medicare, Medicaid, and other federal healthcare programs such as TriCare. Several recent cases bring home the realization that many activities that are common in other industries are a crime under federal healthcare fraud and abuse laws.
Hospital executives, as well as physicians and/or other health care providers, should be very concerned about the potential for the government to use the AKS as one of the prime methods for enforcing federal fraud and abuse laws. Equally concerning, along with Stark II (the federal physician anti-referral law), the AKS can be and is being used as the basis for an action brought under the Federal False Claims Act.
In this webinar, you will learn about the elements of the AKS, along with the various exceptions and safe harbors that you can rely on for protection against enforcement under these laws. This is important because healthcare fraud and abuse if becoming the focus of these enforcement efforts.
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The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works. It will also provide an assessment of enforcement activities, showing how healthcare providers may be at risk. In addition, the session will review recent cases and show how they potentially impact healthcare providers.
We will start with a review of the Federal False Claims Act and discuss how it works and how it is being used to fight health care fraud. We will discuss how the various health care fraud task forces use the Federal False Claims Act and its whistleblower provisions
to identify and prosecute health care fraud. The webinar will take the Federal False Claims Act apart and show step by step how an action is filed, how the government responds and how the courts interpret various elements of the Act. We will discuss proof, damages under the Act and how the whistleblower is rewarded for bringing a successful case.
The session will also provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as a general review the AKS available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law.
We will also review the changes made to both the False Claims Act and the AntiKickback Statute made by the Affordable Care Act.
Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it. In addition, we will discuss the latest updates to both the False Claims Act and the Anti-Kickback Statute.
Recent cases and/or enforcement actions involving the FCA raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.
This session is designed for healthcare executives, attorneys and consultants who advise health care executives and others who want to learn about the False Claims Act. The health care executive, physician or other health care provider, should be very concerned about the potential for enforcement actions under the FCA. This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced. Recovery under the FCA last year resulted in over $3.1 billion being recovered for the federal government, $24.2 billion since the law was revised to make it more relator friendly in 1986.
In FY 2020, the Department of Justice (DOJ) opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year. Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises. In FY 2020, investigations conducted by HHS’s Office of Inspector General (HHS-OIG) resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider selfdisclosure matters. HHS-OIG also excluded 2,148 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.
Since 1986, whistleblowers have been awarded nearly $4 billion and whistleblowers are where a majority of the FCA suits originate. Several recent cases involving healthcare providers have resulted in huge settlements. If that is not enough to get your attention, consider the recent cases finding that the “responsible corporate officer doctrine” allows the government to hold hospital CEOs and others directly responsible for the fraud. In a recent case, executives paid $1 million to settle allegations of fraud and were excluded from participation in federal health care programs. You will want to attend this webinar to learn how to protect your healthcare providers.
Venue: Recorded Webinar
A hospital chargemaster is a comprehensive list of a hospital's products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster. Major components include revenue codes that reflect the site of service and applicable CPT/HCPCS codes that indicate the service provided/charged. Poor matches between these code sets may lead to distorted cost centers, lost revenue, charges bundled that should be separately reported and incomplete departmental charging. Webinar’s Goals Understand chargemaster code functions Understand revenue leakage resulting from poor chargemaster structure Understand why correct departmental charging is vital to revenue integrity Appropriate training for charge entry staff Billing attention to posted charges Who Should Attend Chargemaster Maintenance Staff Compliance staff Billers Coders Revenue Cycle Managers & Staff Risk Management Charge entry staff
Clinical documentation is the cornerstone for all patient medical records. This information should be of the highest quality to allow for optimal patient outcomes as well as supporting research, medical coding and other uses of the medical record. Its purpose is to adequately relate the patient’s current and historical conditions and treatments with primary focus placed on situations that affect the current medical encounter. It also supports the provider’s defense should the case become a legal issue. Webinar’s Goals Review of 7 criteria that all entries in the medical record should include Impact of documentation on coding & claims Establishing a CDI team Significance of abnormal lab results: querying the provider. Measurement of lesions, when taken and inclusion of margins. Why it matters & how reimbursement may be affected. Start & stop times & methodology for infusions & discrepancies in billing. Complete reporting for administration and substance. Diagnostic testing and medications should be supported in a diagnosis. Unsupported documentation may cost you money. Depth of wounds and cause should be clear. Clarity needed for both depth and origin of wound. Severity of illness. Hospitals and payers are increasingly scrutinizing patient severity. Lack of detail costs money. Diagnosis present on admission? Certain conditions do not generate additional revenue if occurrence after admission. Areas Covered The ICD-10 code set requires explicit documentation of conditions & treatments in order to support the severity of patients under treatment as well as allow for the significant specificity required by this code set. Ambiguous documentation and generic coding will no longer guarantee reimbursement and may generate a claims denial for lack of medical necessity. In this session, we will review the theory of high-quality clinical documentation which has the support of healthcare regulatory guidelines and peer-review research. Additional consideration involves medical outcomes that may result in legal action. When clinical documentation is vague, missing key elements and conflicting statements, the provider may find that he/she is handicapped in supporting medical decisions and patient results, particularly when the result is a negative outcome for the patient. In today’s healthcare environment, many patients have become educated consumers of medical services. They are more inclined to request their own medical record, carefully review explanation of benefits from payers, and request a review of any information they deem to be incomplete or questionable. Target Audience Coding Billing Revenue Cycle Physicians Mid-level providers Nurses Claims follow-up Compliance Auditors
Elevate your Excel prowess with this training. Aimed at users already versed in Excel's core functions (SUM, X/VLOOKUP, COUNTIF etc), this course introduces users to some of the new innovative functions added since 2020, exclusively available to Microsoft 365 and Excel 2021 users. These cutting-edge tools are designed to streamline your formula creation process, enhance your data interaction, and expand your analytical capabilities. Embrace the simplicity of extracting unique values, sorting and filtering datasets, creating dynamic, self-updating lists and much more! Whether you’re looking to improve efficiency, accuracy, or both, these features will set you on a path to becoming an Excel ninja. Ensure your skill set remains at the forefront of technological advancements with these essential, transformative functions that redefine what's possible in Excel. Topics We’ll Explore UNIQUE: Extract distinct values effortlessly FILTER: Refine your data with precision SEQUENCE: Generate ordered lists automatically SORT & SORTBY: Arrange your data with ease CHOOSECOLS & CHOOSEROWS: Select specific data segments TEXSPLIT, TEXTBEFORE, and TEXTAFTER: Manipulate text data like never before VSTACK: Merge arrays vertically with simplicity Who Should Attend? This intermediate-level training is tailored for Excel users eager to learn the cutting-edge functions exclusive to Microsoft 365 subscribers and Excel 2021 users. Prior to attending, confirm with your IT department whether your subscription includes these features.