Navigating the Healthcare Fraud and Abuse Legal Maze

Description

This presentation is for healthcare providers, to assist them in making decisions that follow healthcare laws and regulations, which are extremely complicated and complex. Healthcare fraud and abuse is rapidly becoming a growth industry.  With the scope of federal healthcare programs, including Medicare, Medicaid, and TriCare, just to name a few, the potential for fraud is enormous. The federal government enforcement activities, the Department of Justice (DOJ), the Office of the Inspector General, Department of Health and Human Services (OIG) and a multitude of other federal agencies, are providing increased time, staff, and resources, to provide increased scrutiny to all types of healthcare providers.  Employees, independent contractors, consultants, including attorneys, management, and the board of directors, all face potential liability. 

We will start with an overview of healthcare fraud and abuse, reviewing what healthcare fraud and abuse is and how it impacts healthcare practice. Next, we will review 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

We will discuss the Anti-Kickback Statute (AKS), including its prohibitions, intent requirements, and definitions of indirect payments, including a review of the Federal Medicare and Medicaid Patient and Program Protection Act, which amended the Anti-Kickback Statute to provide protection for standard business practices, We will review the regulations that resulted, the “Safe Harbors,”  We will show how these safe harbors protect certain business transactions and how the regulations can easily be violated.  

Next we will discuss  the Federal Anti-Referral Act, better known as Stark Law, including a review of exceptions to this law. 

Objectives 

To provide attendees with an understanding of fraud and abuse laws, their various elements, how they t work, and how to protect one’s organization from this potent enforcement tools.

Areas Covered in the Presentation

• A review of the Federal False Claims Act, its history, how it works, its proof requirements, pleading requirements and damages.
• A review of the Anti-Kickback Statute and its safe harbors.
• A review of the federal anti-referral law. 

Why Should you attend

This session is designed for health care executives and physicians. The health care executive, physician or other health care provider, should be very concerned about the potential for enforcement actions under the FCA, AKS and Stark.  This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced.  Recovery under last year resulted in over $4.9 billion being recovered for the federal government, $24.2 billion since the law was revised to make it more relator friendly in 1986.

Since 1986, whistleblowers have been awarded nearly $4 billion, with $439 million in awards in fiscal year 2020. 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 yourself and your organization.

Who Should Attend

• Healthcare executives.
• Compliance officers.
• Physicians. 
• Physician practice managers.