This webinar is sponsored by the Fraud and Abuse Practice Group.
|
|
- Osborn Rodgers
- 6 years ago
- Views:
Transcription
1 Trends in Health Care Enforcement: Past, Present, and Future July 21, :30-4:45 Eastern This webinar is sponsored by the Fraud and Abuse Practice Group. Faculty : Susan Winkler Assistant U.S. Attorney, U.S. Attorney s Office, Boston, MA Susan.Winkler@usdoj.gov Laura Laemmle-Weidenfeld Jones Day, Washington, DC lweidenfeld@jonesday.com 1
2 Early Stages of Health Care Fraud Enforcement False Claims Act Amendments of 1986 Health Insurance Portability and Accountability Act (HIPAA), 1996 Expansion of enforcement resources in USAOs, Main DOJ, FBI, HHS-OIG Health care fraud focus in Boston USAO, other key USAOs Coordination between USAOs, Main DOJ Internal structure for health care fraud team in Boston USAO, contrasted with other USAOs Development of caselaw under which violations of Antikickback Statute and other laws could trigger FCA liability Expansion into pharmaceuticals, medical devices 2
3 HCFAC Report for FY 1997 $1.087 billion collected in criminal fines, civil judgments/settlements, and administrative sanctions $968 million returned to Medicare Trust Fund $31 million recovered as federal share of Medicaid More than 2700 individuals and entities excluded (93% increase over 1996) 4,010 civil health care matters opened (61% increase over 1996) 3
4 HCFAC Report for FY 2013 $4.3 billion collected from health care fraud matters $2.85 billion went to Medicare Trust Funds Over $576 million recovered as federal share of Medicaid HCFAC has returned over $25.9 billion to Medicare Trust Funds since inception in 1997 FY 2013, DOJ opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants. FY 2013, DOJ opened 1,083 new civil health care fraud investigations FY 2013, HHS-OIG investigations resulted in 849 criminal actions, 458 civil actions, and 3,214 exclusions 4
5 Selected USAO Boston Recoveries Year Case Criminal Civil 2000 National Medical dialysis 102 million 384 million 2001 TAP Pharmaceuticals free samples 290 million 596 million 2003 Bayer Corporation lick and stick 5.59 million 257 million 2004 Warner Lambert off label 190 million 240 million 2005 Serono Laboratories kickbacks and fraud in sales 136 million 567 million 2006 Schering Plough kickbacks/off-label 180 million 255 million 2007 Pharmacia kickbacks 19 million 2009 Pfizer off label, kickbacks 1.3 billion 1 billion 2010 GSK Cidra cgmp 150 million 600 million 2011 Forest Laboratories off label/ kickbacks/obstruction 164 million 149 million 2012 Merck off label/safety 321 million 628 million 2012 GSK off label/safety 1 billion 2 billion
6 Recent Trends in Health Care Fraud Enforcement Impact of FCA revisions via FERA/ACA Focus on individuals as targets (civilly and criminally) Parallel investigations Increase in qui tams Strike Force/HEAT Pharma and device cases Use of FCA and criminal enforcement to pursue regulatory violations Attorney-client privilege sensitivities Use of DPAs, monitorships Activity by state Ags FCPA 6
7 FY 2013 FCA Enforcement Statistics 752 new qui tam matters filed Total federal health care recoveries under the FCA exceeded $2.5 billion $1.8 billion from alleged false claims for drugs and medical devices reimbursed under Federal health care programs Additional $443 million for state Medicaid programs Total reward paid to qui tam relators in health care cases was $345 million 7
8 Future Issues in Health Care Fraud Enforcement Impact of Affordable Care Act Medicaid expansion HIPAA Other? 8
9 Trends in Health Care Enforcement: Past, Present, and Future 2014 is published by the American Health Lawyers Association. All rights reserved. No part of this publication may be reproduced in any form except by prior written permission from the publisher. Printed in the United States of America. Any views or advice offered in this publication are those of its authors and should not be construed as the position of the American Health Lawyers Association. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is provided with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice or other expert assistance is required, the services of a competent professional person should be sought from a declaration of the American Bar Association 9
Fraud in the Pharmaceutical Industry
Fraud in the Pharmaceutical Industry The United States qui tam Whistleblower Law Getnick & Getnick LLP Counsellors At Law Rockefeller Center, 620 Fifth Avenue New York, NY 10020 Phone: (212) 376-5666 Fax:
More informationIndustry Funding of Continuing Medical Education
Industry Funding of Continuing Medical Education June 25, 2010 Julie K. Taitsman, M.D., J.D. Chief Medical Officer, Office of Inspector General U.S. Department of Health and Human Services Financial Relationships
More informationPATRICK S. COFFEY. Chicago, IL office: office:
PATRICK S. COFFEY Partner Milwaukee, WI Chicago, IL office: 312.523.2080 office: 414.978.5538 email: patrick.coffey@ Overview When clients are faced with difficult problems, Pat puts them at ease. He uses
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Office of Inspector General s Use of Agreements to Protect the Integrity of Federal Health Care Programs
United States Government Accountability Office Report to Congressional Requesters April 2018 DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Inspector General s Use of Agreements to Protect the Integrity
More informationCurrent Issues in Patient and Product Support. October 20, 2016
Current Issues in Patient and Product Support October 20, 2016 How Did a Perennial Issue Become the Hot Topic? 1. Reimbursement Support 2. Patient Assistance Programs 3. Donations to Charitable Foundations
More informationOffice of Inspector General. Regional Enforcement Efforts and Priorities in Florida. South Atlantic Regional Conference January 28, 2011
Office of Inspector General Regional Enforcement Efforts and Priorities in Florida Health Care Compliance Association South Atlantic Regional Conference January 28, 2011 Felicia Heimer, Esq. Office of
More informationIt s Here: The Final 60 Day Overpayment Rule
It s Here: The Final 60 Day Overpayment Rule (What it means for you and your clients) Hillary M. Stemple, Esq. Associate Arent Fox LLP Washington, DC 20006 hillary.stemple@arentfox.com December 5, 2017
More informationFAST BREAK: GOVERNMENT ENFORCEMENT OF INDIVIDUAL ACCOUNTABILITY. Katie McDermott Jacob Harper February 28, Morgan, Lewis & Bockius LLP
FAST BREAK: 2015 Morgan, Lewis & Bockius LLP GOVERNMENT ENFORCEMENT OF INDIVIDUAL ACCOUNTABILITY Katie McDermott Jacob Harper February 28, 2017 2015 Morgan, Lewis & Bockius LLP Discussion Agenda Individual
More informationState False Claims Acts
State False Claims Acts How States Can Recover Stolen Money Jim Moorman, TAF Roderick Chen, OIG-HHS The Scope of the Fraud No one knows for sure how much fraud infects Medicaid and Medicare. The U.S. Government
More informationHEATHER I. BATES Managing Director, BRG Health Analytics. BERKELEY RESEARCH GROUP, LLC 1800 M Street NW, 2 nd Floor Washington, DC 20036
Curriculum Vitae HEATHER I. BATES Managing Director, BRG Health Analytics BERKELEY RESEARCH GROUP, LLC 1800 M Street NW, 2 nd Floor Washington, DC 20036 Direct: 202.480.2660 Cell: 202.641.1035 hbates@thinkbrg.com
More informationAnalysis of the New Medicare Part D Drug Benefit and Changes to Medicare Part B Reimbursement: New Rules of the Road
National Medicare Prescription Drug Congress Analysis of the New Medicare Part D Drug Benefit and Changes to Medicare Part B Reimbursement: New Rules of the Road T. Reed Stephens Health Care Practice Group
More informationManaging Financial Interests: The Anti Kickback Statute (AKS)
Managing Financial Interests: The Anti Kickback Statute (AKS) Board of Commissioners Meeting February 15, 2012 Presented by: Mic Sager, Compliance Officer Context: Business Transactions o Health Care is
More informationFrom the Office Suite to Cell Block C: Potential Criminal and Regulatory Implications of Pharma/Biotech/Device Products Liability Lawsuits
From the Office Suite to Cell Block C: Potential Criminal and Regulatory Implications of Pharma/Biotech/Device Products Liability Lawsuits BUTLER SNOW 1 UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT
More informationImproving Integrity in Nursing Centers
Improving Integrity in Nursing Centers Susan Edwards Reed Smith LLP AHCA/NCAL s General Counsel Goals of this webinar Introduce you to AHCA/NCAL s Fraud and Abuse Toolkit Provide you with a basic understanding
More informationPotential Perils of Using New Media in Marketing and Promotion. Christina M. Markus (202)
Potential Perils of Using New Media in Marketing and Promotion Christina M. Markus (202) 626-2926 cmarkus@kslaw.com FACEBOOK Using Facebook to develop online community TWITTER Using Twitter as another
More informationAnti-Kickback Statute and False Claims Act Enforcement
Anti-Kickback Statute and False Claims Act Enforcement Nicholas Gachassin, III, Esq. Gachassin Law Firm, LLC Nick3@gachassin.com Press Conference on Health Care Fraud and the Affordable Care Act May 13,
More informationU.S. v. Sulzbach: Government Theories, Potential Defenses, and Lessons Learned
U.S. v. Sulzbach: Government Theories, Potential Defenses, and Lessons Learned Presented By: David O Brien Christine Rinn Michael Paddock HOOPS 2007 - Washington, DC October 15-16 Background June 1994:
More informationRepay Overpayments (18 USC 1347; 42 CFR et seq.)
Repay Overpayments (18 USC 1347; 42 CFR 401.301 et seq.) Repaying Overpayments If provider has received an overpayment, provider must: Return the overpayment to federal agency, state, intermediary, or
More informationCoding Partners in Patient Safety
Coding Partners in Patient Safety Senior Loss Prevention Attorney UF Self Insurance Programs Learning Objectives Understand federal fraud and abuse laws and the importance of coders in avoiding issues.
More informationCorporate Integrity Agreements can be the basis for a False Claims Act Case
Corporate Integrity Agreements can be the basis for a False Claims Act Case by Suzanne E. Durrell, Esq. Washington D.C. November 2014 Who should read this paper Presented by Atty. Suzanne E. Durrell at
More informationGERALD (JERRY) LEWANDOWSKI. BERKELEY RESEARCH GROUP, LLC 1800 M Street NW, Second Floor Washington, DC 20036
Curriculum Vitae GERALD (JERRY) LEWANDOWSKI BERKELEY RESEARCH GROUP, LLC 1800 M Street NW, Second Floor Washington, DC 20036 Direct: 202.480.2643 Mobile: 202.258.2669 jlewandowski@thinkbrg.com Jerry Lewandowski
More informationThis course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including:
This course is designed to provide Part B providers with an overview of the Medicare Fraud and Abuse program including: Medicare Trust Fund Defining Fraud & Abuse Examples of Fraud & Abuse Fraud & Abuse
More informationThe False Claims Act and Financial Institutions: A New Role for an Old Statute
The False Claims Act and Financial Institutions: A New Role for an Old Statute D. Jean Veta Ethan M. Posner Benjamin J. Razi July 18, 2012 Agenda 1. Background on False Claims Act 2. FCA in healthcare
More informationThe Stark Law and Self-Disclosure:
The Stark Law and Self-Disclosure: What Should You Do After Discovering a Potential Stark Violation? Healthcare Horizons Webinar Series September 25, 2012 Husch Blackwell LLP Welcome Brian Bewley, Partner
More informationWill Life Sciences Companies Face More Scrutiny In 2018?
Will Life Sciences Companies Face More Scrutiny In 2018? By John Bentivoglio and Jennifer Bragg The pace of U.S. Department of Justice settlements with life sciences companies slowed in 2017, with eight
More informationFalse Claims Act and Mandatory Disclosure Requirements for Federal Contractors
False Claims Act and Mandatory Disclosure Requirements for Federal Contractors Presenters: Robert T. Rhoad, Esq. & Dalal Hasan, Esq. 2012 Crowell & Moring LLP All Rights Reserved False Claims Act: Recent
More informationWhistleblowing Under the False Claims Act
Whistleblowing Under the False Claims Act Session 303, March 9, 2018 Colette G. Matzzie, Partner, Phillips & Cohen LLP Brendan Delaney, Implementation Specialist, Whistleblower 1 Conflict of Interest Colette
More informationFraud and Abuse Compliance for the Health IT Industry
Fraud and Abuse Compliance for the Health IT Industry Session 89, March 6, 2018 James A. Cannatti III, Senior Counselor for Health Information Technology, U.S. Department of Health and Human Services (HHS),
More informationFalse Claims Act and Mandatory Disclosure Requirements for Federal Contractors
False Claims Act and Mandatory Disclosure Requirements for Federal Contractors Presenters: Robert T. Rhoad, Esq. & Dalal Hasan, Esq. 2012 Crowell & Moring LLP All Rights Reserved False Claims Act: Recent
More informationDefending Whistleblower Cases: An Advanced View From the Trenches. Gregory M. Luce Jones Day
Defending Whistleblower Cases: An Advanced View From the Trenches Gregory M. Luce Jones Day www.hcca-info.org 888-580-8373 Whistleblower Actions False Claims Act Statute prohibiting fraud against the government
More informationSelf-Disclosure: Why, When, Where and How
American Bar Association Washington Health Law Summit Self-Disclosure: Why, When, Where and How December 8, 2015 Margaret Hutchinson U.S. Attorney s Office for the Eastern District of Pennsylvania Kaitlyn
More information1/29/2011. Mark G. Bodner Bureau Chief Complex Civil Enforcement Bureau Medicaid Control Unit Office of the Attorney General
Mark G. Bodner Bureau Chief Complex Civil Enforcement Bureau Medicaid Control Unit Office of the Attorney General The enactment of the Medicare and Medicaid Anti-Fraud and Abuse Amendments of 1977 authorized
More informationWhat s On Tap? Who Are the Players? 4/3/2017. Healthcare Enforcement Trends What To Do When the Government Comes Knocking?
Healthcare Enforcement Trends What To Do When the Government Comes Knocking? Holly Logan Craig Sieverding 1 What s On Tap? Enforcement landscape, generally Fraud and Abuse Update o Brief primer on major
More informationHealth Care Fraud for Physicians
Health Care Fraud for Physicians UNM Family Medicine Residency Program May 25, 2011 Or... Why I Should Have Never Become A Doctor In The First Place Fraud Fraud vs. Abuse Intentional deception or misrepresentation
More informationStark Self-Disclosure. Thomas S. Crane 1/ Mintz Levin Cohn Ferris Glovsky and Popeo, PC
Stark Self-Disclosure Thomas S. Crane 1/ Mintz Levin Cohn Ferris Glovsky and Popeo, PC A. Background 1. Stark Law The Physician Self-Referral Statute (or the Stark Law ) prohibits a physician from referring
More informationFALSE CLAIMS ACT ENFORCEMENT: RECENT TRENDS AND STEPS TO ENSURE COMPLIANCE AND AVOID FRAUD ALLEGATIONS
FALSE CLAIMS ACT ENFORCEMENT: RECENT TRENDS AND STEPS TO ENSURE COMPLIANCE AND AVOID FRAUD ALLEGATIONS The Carolinas Center s 39 th Annual Hospice & Palliative Care Conference Columbia, SC Presenters:
More informationThe False Claims Act and Off-Label Promotion: Understanding and Minimizing the Risks for Pharmaceutical Manufacturers
4th Annual Pharmaceutical Regulatory Congress November 12, 2003 The False Claims Act and Off-Label Promotion: Understanding and Minimizing the Risks for Pharmaceutical Manufacturers John T. Bentivoglio
More informationConflicts of Interest 9/10/2017. Everything a Health Care Executive Needs to Know about the Anti-Kickback Statute. May 2, 2017 Article from JAMA:
Everything a Health Care Executive Needs to Know about the Anti-Kickback Statute Matthew Krueger Assistant United States Attorney E.D. of Wisconsin Stacy Gerber Ward von Briesen & Roper, S.C. Conflicts
More informationThe False Claims Act. False Claims Act Basics (I)
The False Claims Act Basic Concepts, Recent Trends, and Strategies for Minimizing Risks Philip D. Robben February 26, 2013 False Claims Act Basics (I)! Imposes liability on those who submit false claims
More informationKeys to Negotiating a Corporate Integrity Agreement. A Presentation to the Pharmaceutical Congress
Keys to Negotiating a Corporate Integrity Agreement A Presentation to the Pharmaceutical Congress November 13, 2003 athon L. Kellerman ior Manager ewaterhousecoopers LLP 7) 330-2466 athan.l.kellerman@us.pwc.com
More information11/10/2014. Nuts and Bolts of Proceedings related to Fraud, Recent Cases Update, and HIPAA Nuances. Objectives
Nuts and Bolts of Proceedings related to Fraud, Recent Cases Update, and HIPAA Nuances Presented to: Health Care Compliance Association November 14, 2014 Objectives Background and General Trends on fraud
More informationMATTHEW T. SCHELP. St. Louis, MO office:
MATTHEW T. SCHELP Partner St. Louis, MO office: 314.480.1772 email: matthew.schelp@ Overview A former federal prosecutor, Matt concentrates his practice in the areas of compliance, internal investigations,
More informationCBI PAP LEGAL UPDATE MEDICARE & MEDICAID A REVIEW OF COMPLIANCE WITH GOVERNMENT PROGRAMS. September 26, Sarah difrancesca Partner Cooley LLP
CBI PAP LEGAL UPDATE MEDICARE & MEDICAID A REVIEW OF COMPLIANCE WITH GOVERNMENT PROGRAMS September 26, 2017 Sarah difrancesca Partner Cooley LLP attorney advertisement Copyright Cooley LLP, 3175 Hanover
More informationREGULATORY ISSUES IMPACTING SUPPLY CHAIN
REGULATORY ISSUES IMPACTING SUPPLY CHAIN Michael Nachman Associate General Counsel John W. Jones, Jr. Partner Allan A. Thoen Partner April 27, 2017 2017 In House Counsel Conference Presenters: John W.
More informationDEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All MASSACHUSETTS WORKFORCE MEMBERS
DEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All MASSACHUSETTS WORKFORCE MEMBERS The Company is committed to preventing health care fraud, waste and abuse and complying with applicable
More informationPanelists. ABA 31 st Annual National Institute on White Collar Crime. Healthcare Fraud and Abuse Panel
Prepared for ABA 31 st Annual National Institute on White Collar Crime Healthcare Fraud and Abuse Panel March 8, 2017 Panelists Greg Noonan (Moderator) Collora LLP Boston, Massachusetts Joseph F. Savage
More informationThe Anesthesia Company Model: Frequently Asked Questions
The Anesthesia Company Model: Frequently Asked Questions 1. What is the situation in Florida? Florida-specific Issues For several years, FSA members have been contacting the society with reports of company
More informationHealth Care Practice Center
Health Care Practice Center Power your practice. 800.372.1033 bna.com/bloomberglaw Seamlessly integrated intelligence. Practice pages Navigate the nuances of health care law. Bloomberg Law s Health Care
More informationRegion 10 PIHP FY Corporate Compliance Program Plan
Region 10 PIHP FY 2018 Corporate Compliance Program Plan 1 Mission The purpose of the Region 10 Corporate Compliance Program Plan is to provide quality care for all the individuals it serves by acting
More informationMANAGING HOME HEALTH AND HOSPICE REGULATORY RISK IN THE NEW HEALTH CARE ECONOMY
MANAGING HOME HEALTH AND HOSPICE REGULATORY RISK IN THE NEW HEALTH CARE ECONOMY By: Thomas William Baker, Esq. Baker Donelson Bearman Caldwell & Berkowitz, PC (404) 221-6510 (Phone) (404) 238-9640 (Facsimile)
More informationA DISCUSSION WITH THE OIG
1 A DISCUSSION WITH THE OIG MICHAEL J ARMSTRONG REGIONAL INSPECTOR GENERAL FOR AUDIT SERVICES STEPHEN J CONWAY DIRECTOR, ADVANCED AUDIT TECHNIQUES ROBERT K DECONTI CHIEF, ADMINISTRATIVE & CIVIL REMEDIES
More informationMission Statement. Compliance & Fraud, Waste and Abuse Training for Network Providers 1/31/2019
Compliance & Fraud, Waste and Abuse Training for Network Providers Mission Statement To promote the quality of life of our communities by empowering others and working together to creatively solve unique
More informationThe ACA s New Provider Compliance Program Mandate Turning a Mandatory Compliance Program into a Strategic Advantage
! The ACA s New Provider Compliance Program Mandate Turning a Mandatory Compliance Program into a Strategic Advantage On March 23, 2010, President Obama signed into law the Patient Protection and Affordable
More informationThe Perils Of Pharma: The Pharmaceutical Industry And The FCPA
W O R L D - C H E C K W H I T E P A P E R The Perils Of Pharma: The Pharmaceutical Industry And The FCPA by Michael Osajda Statement of intent In recent years, the pharmaceutical industry has been subjected
More informationNew Government Theories of Civil Liability for Off-Label Promotion: Are They Legitimate?
BEIJING BRUSSELS CHICAGO DALLAS FRANKFURT GENEVA HONG KONG LONDON LOS ANGELES NEW YORK SAN FRANCISCO SHANGHAI SINGAPORE TOKYO WASHINGTON, D.C. New Government Theories of Civil Liability for Off-Label Promotion:
More informationH e a l t h C a r e Compliance Adviser
March 2001 Volume 5 Number 1 H e a l t h C a r e Compliance Adviser OIG Issues New Advisory Opinion on Gainsharing Reversing July 1999 Special Advisory Bulletin In a welcome departure from its former position,
More informationMedicare Program Integrity: Overview and Issues
Medicare Program Integrity: Overview and Issues Marjorie Kanof, M.D. Managing Director, Health Care U.S. Government Accountability Office February 22, 2007 1 Overview Introduction to Medicare What is Program
More informationWhat is a Compliance Program?
Course Objectives Learn about the most important elements of the compliance program; Increase awareness and effectiveness of our compliance program; Learn about the important laws and what the government
More informationStructuring Specialty Pharmacy Distribution Arrangements in a Turbulent Regulatory Environment Mini Summit XVIII
Structuring Specialty Pharmacy Distribution Arrangements in a Turbulent Regulatory Environment Mini Summit XVIII The 16 th Pharmaceutical Compliance Congress and Best Practices Forum Thursday, October
More informationIndustry Consolidation: Role of Compliance in Mergers, Acquisitions, and Divestitures
Industry Consolidation: Role of Compliance in Mergers, Acquisitions, and Divestitures Prepared for CBI s Pharmaceutical Compliance Congress April 28, 2017 M&A Activity in the Pharmaceutical Industry THE
More informationFRAUD, WASTE, & ABUSE (FWA) for Brokers. revised 10/17
FRAUD, WASTE, & ABUSE (FWA) for Brokers revised 10/17 OBJECTIVES After reviewing this information, you will be able to: Understand Fraud, Waste, and Abuse (FWA) training requirements; Be familiar with
More informationSpecial Advisory Bulletin
Special Advisory Bulletin The Effect of Exclusion From Participation in Federal Health Care Programs September 1999 A. Introduction The Office of Inspector General (OIG) was established in the U.S. Department
More informationDisclaimer LEGAL ISSUES IN PHYSICAL THERAPY
LEGAL ISSUES IN PHYSICAL THERAPY Paul J. Welk, PT, JD Tucker Arensberg, P.C. pwelk@tuckerlaw.com 2017 PHCA Annual Convention 1 Disclaimer The purpose of this presentation is to provide a general overview
More informationRESEARCH ENFORCEMENT Grant Fraud, Research Billing Irregularities and Other Scary Research Enforcement Issues
Kelly M. Willenberg, DBA, MBA, BSN, RN, CHRC, CHC Owner, Kelly Willenberg & Associates RESEARCH ENFORCEMENT Grant Fraud, Research Billing Irregularities and Other Scary Research Enforcement Issues 6TH
More informationOff-label Promotion: Enforcement Tools and Trends. Holly A. Pierson, Nelson Mullins LLP
Off-label Promotion: Enforcement Tools and Trends Holly A. Pierson, Nelson Mullins LLP Holly.Pierson@NelsonMullins.com 1 Off-Label Enforcement Primer 2 The Basics The FDCA prohibits manufacturers from:
More informationHOSPITAL COMPLIANCE POTENTIAL IMPLICATION OF FRAUD AND ABUSE LAWS AND REGULATIONS FOR HOSPITALS
HOSPITAL COMPLIANCE H C C A R E G I O N A L C O N F E R E N C E A P R I L 2 8, 2 0 1 6 S A N J U A N, P U E R T O R I C O S A N C H E Z B E T A N C E S, S I F R E & M U Ñ O Z N O Y A, C S P J A I M E S
More informationMedical Ethics. Paul W. Kim, JD, MPH O B E R K A L E R
Medical Ethics Paul W. Kim, JD, MPH O B E R K A L E R 410-347-7344 pwkim@ober.com 1 Agenda Federal Fraud & Abuse Laws Federal Privacy Laws Enrollment Audits Post-Payment Audits Pre-Payment Reviews 2 False
More informationMedical Loss Ratio. Institute for Health Plan Counsel May 8, Presenters:
Medical Loss Ratio Institute for Health Plan Counsel May 8, 2013 Presenters: Melissa J. Hulke, CPA, ABV, CFF Navigant, Phoenix, AZ melissa.hulke@navigant.com Scott O. Jones, FSA, MAAA Milliman, Seattle,
More informationSTRIDE sm (HMO) MEDICARE ADVANTAGE Fraud, Waste and Abuse
Fraud, Waste and Abuse Detecting and preventing fraud, waste and abuse Harvard Pilgrim is committed to detecting, mitigating and preventing fraud, waste and abuse. Providers are also responsible for exercising
More informationBeneficiary Inducements
1 Beneficiary Inducements Heidi A. Sorensen HCCA South Central Regional Annual Conference November 12, 2010 Attorney Advertising Prior results do not guarantee a similar outcome Models used are not clients
More informationDefending Corporations and Individuals in Government Investigations Ethics & Whistleblower Issues In Investigations
Defending Corporations and Individuals in Government Investigations Ethics & Whistleblower Issues In Investigations Daniel J. Fetterman Mark P. Goodman Reid Figel Daniel Karson Patrick Pericak September
More informationHEALTH CARE FRAUD. EXPERT ANALYSIS HHS OIG Adopts New Anti-Kickback Safe Harbor and Civil Monetary Penalty Exceptions
Westlaw Journal HEALTH CARE FRAUD Litigation News and Analysis Legislation Regulation Expert Commentary VOLUME 22, ISSUE 7 / JANUARY 2017 EXPERT ANALYSIS HHS OIG Adopts New Anti-Kickback Safe Harbor and
More informationDEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All NEW YORK WORKFORCE MEMBERS
DEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All NEW YORK WORKFORCE MEMBERS The Company is committed to preventing health care fraud, waste and abuse and complying with applicable state
More informationTelemedicine Fraud and Abuse Under the Microscope
Telemedicine Fraud and Abuse Under the Microscope Session 232, February 14, 2019 Douglas Grimm, Esq., Arent Fox LLP Hillary Stemple, Esq., Arent Fox LLP 1 Conflicts of Interest Douglas Grimm, Esq. Has
More informationDisclosures to the Government:
Disclosures to the Government: Whether, Where, When, Why and What to Expect Dallas Bar Association Health Law Section January 16, 2019 Frank Sheeder, Partner Frank.Sheeder@Alston.com Alston & Bird LLP
More informationMedicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and Abuse
Order Code RL34217 Medicare Program Integrity: Activities to Protect Medicare from Payment Errors, Fraud, and Abuse October 24, 2007 Holly Stockdale Analyst in Medicare Domestic Social Policy Division
More informationFederal Fraud and Abuse Enforcement in the ASC Space
Federal Fraud and Abuse Enforcement in the ASC Space SCOTT R. GRUBMAN, ESQ. PARTNER CHILIVIS COCHRAN LARKINS & BEVER, LLP (ATLANTA GA) Fraud & Abuse Enforcement Landscape FBI CMS OCR MFCU DCIS DOJ HHS-OIG
More informationDeciphering the Self-Disclosure Puzzle
Deciphering the Self-Disclosure Puzzle ABA Health Law Section Emerging Issues in Healthcare Law Bill Mathias 410.347.7667 wtmathias@ober.com Lisa Ohrin 410.786.8852 Lisa.Ohrin1@cms.hhs.gov February 28,
More informationDavid J. Leviss Partner
David J. Leviss Partner Washington, DC D: +1-202-383-5282 dleviss@omm.com A recognized authority on False Claims Act-related issues, David Leviss focuses his practice on defending corporations and individuals
More informationFlorida Health Law Traps -
and Gassman Law Associates, P.A. present Lester Perling lperling@broadandcassel.com Alan S. Gassman agassman@gassmanpa.com Florida Health Law Traps - 5 Hypotheticals and Discussion of Important Medical
More informationCorporate Compliance Program. Intended Audience: All SEH Associates 2016 Content Expert: Lisa Frey -
Corporate Compliance Program Intended Audience: All SEH Associates 2016 Content Expert: Lisa Frey - lisa.frey@stelizabeth.com Developed 2012, reviewed Dec 2015 What is Corporate Compliance? Hospitals,
More informationAnti-Kickback Statute Compliance in Healthcare Transactions
Presenting a live 90-minute webinar with interactive Q&A Anti-Kickback Statute Compliance in Healthcare Transactions Navigating Safe Harbors, Identifying Transactions That Implicate AKS, Limiting Civil
More informationSelf Funded Provider Manual. Self Funded Provider Manual 1. Section 8: Compliance
Self Funded Provider Manual Section 8 Compliance Self Funded Provider Manual 1 Table of Contents 8 SECTION 8: COMPLIANCE... 3 8.1 COMPLIANCE WITH LAW... 3 8.2 KAISER PERMANENTE PRINCIPLES OF RESPONSIBILITY
More informationContracting with Specialty Pharmacies and Hubs 17 th Annual Pharma and Medical Device Compliance Congress. October 20, 2016
Contracting with Specialty Pharmacies and Hubs 17 th Annual Pharma and Medical Device Compliance Congress October 20, 2016 Thomas Beimers Hogan Lovells Thomas.beimers@hoganlovells.com Sarah Franklin Covington
More informationThis Webcast Will Begin Shortly
This Webcast Will Begin Shortly If you have any technical problems with the Webcast or the streaming audio, please contact us via email at: webcast@acc.com Thank You! 1 How to Avoid False Claims Act Exposure:
More informationNewYork-Presbyterian Hospital Sites: All Centers Hospital Policy and Procedure Manual Number: D160 Page 1 of 8
Page 1 of 8 TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005 FRAUD AND ABUSE PROVISIONS POLICY: NewYork- Presbyterian Hospital (NYP or the Hospital) is committed to preventing and detecting any fraud, waste,
More informationMFA COMPLIANCE 2016: UNDERSTANDING INSURANCE AND LIABILITY: A FOCUS ON D&O, CYBERSECURITY AND POLICY REVIEWS
MFA COMPLIANCE 2016: UNDERSTANDING INSURANCE AND LIABILITY: A FOCUS ON D&O, CYBERSECURITY AND POLICY REVIEWS Presented by: Lynda A. Bennett Chair, Insurance Recovery Group LOWENSTEIN SANDLER LLP 973.597.6338
More informationPrepared with the Assistance of Jacob Harper, Law Clerk, Morgan Lewis. HHS OIG Exclusion Overview 1
AHLA Institute on Medicare and Medicaid Payment Issues Exclusions and Administrative Sanctions March 20 & 21, 2013 Howard J. Young Partner, Morgan, Lewis & Bockius, LLP Prepared with the Assistance of
More informationFraud, Waste and Abuse: Compliance Program. Section 4: National Provider Network Handbook
Fraud, Waste and Abuse: Compliance Program Section 4: National Provider Network Handbook December 2015 2 Our Philosophy Magellan takes provider fraud, waste and abuse We engage in considerable efforts
More informationLITIGATING AWP. Mitch Lazris/Lyndon Tretter Hogan & Hartson L.L.P. November 15, 2002
LITIGATING AWP Mitch Lazris/Lyndon Tretter Hogan & Hartson L.L.P. November 15, 2002 Litigation Landscape Federal Gov t/states/private Class Actions Payment Systems Medicare (based on 95% of AWP) Medicare
More informationStark and the Anti Kickback Statute. Regulating Referral Relationship. February 27-28, HCCA Board Audit Committee Compliance Conference.
Stark and the Anti Kickback Statute Ryan Meade, JD, CHRC, CHC F Director, Regulatory Compliance Studies Beazley Institute for Health Law and Policy Loyola University Chicago School of Law rmeade@luc.edu
More informationFWA (Fraud, Waste and Abuse) Training
FWA (Fraud, Waste and Abuse) Training Why Do I Need Training or Re Training? Every year billions of dollars are improperly spent because of FWA. It affects everyone including you. This training will help
More informationMedicare Part D: Retiree Drug Subsidy
A D V I S O R Y S E R V I C E S Medicare Part D: Retiree Drug Subsidy Programs to Control Fraud, Waste, and Abuse September, 2006 K P M G L L P Overview Summary Medicare Part D Prescription Drug Program
More informationOffice of the Attorney General Supplemental Budget Request
Office of the Attorney General 2015 Supplemental Budget Request / OFFICE OF THE ATTORNEY GENERAL 2015 Supplemental Budget Request Table of Contents TAB A RECOMMENDATION SUMMARY Recommendation Summary
More informationAnti-Kickback Statute Jess Smith
Anti-Kickback Statute Jess Smith Overview 1972 - Enacted 1977 - Violation became a felony 1996 - Expanded to include all Federal Health Care Programs 2009 - Health Care Fraud Prevention and Enforcement
More informationEffective Collaboration Between Compliance Officers and State and Federal Law Enforcement OBJECTIVES
Effective Collaboration Between Compliance Officers and State and Federal Law Enforcement Elizabeth Lepic, Chief Counsel Illinois State Police Medicaid Fraud Control Unit Ryan Lipinski, CountyCare Compliance
More informationStaying Compliant: A Roadmap to Self-Disclosure
12/18/2015 Staying Compliant: A Roadmap to Self-Disclosure By Linda A. Baumann and Hillary Stemple, Arent Fox LLP The new requirements for overpayment return, along with increasing enforcement, are making
More informationPolicy to Provide Information for Combating Fraud, Waste and Abuse and the Ability of Employees to Report Wrongdoing
1 of 8 and Abuse and the Ability of Employees to Report Wrongdoing 1. Purpose The purpose of this policy is to provide information for combating fraud, waste and abuse and the ability of employees to report
More informationD E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R
D E B R A S C H U C H E R T, C O M P L I A N C E O F F I C E R INTEGRATED CARE ALLIANCE, LLC CORPORATE COMPLIANCE PROGRAM It is the policy of Integrated Care Alliance to comply with all laws governing
More informationMar. 31, 2011 (202) Federal agencies address legal issues regarding Accountable Care Organizations
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE
More information