Overview:This seminar will provide an introduction to health care fraud and abuse and the laws and regulations that the government uses in its enforcement efforts. It will discuss the potential risks, the exposure of organizations, and the likelihood of increased enforcement efforts in the future.
The seminar will discuss the FCA and its implications to health care providers. It will also discuss how violation of other laws and regulations, such as the Anti-Kickback Statute and Stark, provides the basis for a false claim actionable under the Act. It will review both the Anti-Kickback Statute and Stark, along with a safe harbors and exceptions to those statues. It will also discuss civil monetary penalties and the exclusion authorities of the Federal government.
The program will discuss the legal issues surrounding hospital and physician relationships as well as corporate compliance programs and potential liabilities for officers and directors of healthcare organizations.
Areas Covered in the Session:
- Federal False Claims Act (what it is and how it works),
- Federal Civil Anti-Kickback Statute
- Safe Harbors providing protection under the AKS
- Enforcement activities involving the AKS
- Review of Advisory Opinions and Special Fraud Alerts
- Federal Physician Self-Referral Law (including a review of the designated health services and exceptions)
- How the Stark II rules pose dangers for healthcare providers
- Legal Issues Surrounding Hospital and Physician Relationships
- Review of pertinent case law
- Corporate Compliance Programs
- Potential Liabilities for Officers and Directors of Health Care Organizations
Who Will Benefit:
- Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOs
- Nursing home executives
- Physician practice managers
- Other healthcare provider executives
- Attorneys representing health care organizations
Why you should attend:The purpose of this seminar is to tell you how to avoid getting caught up in the fraud and abuse web and how to stay out of trouble with the enforcement authorities.
To put this in perspective, one only has to look at the recoveries from the health care industry by the federal government over the past several years. The number of cases filed since the 1986 amendments has risen from 33 in 1987 to 782 2012, of which 647 were filed by whistleblowers. Since 1986 when Congress amended the False Claims Act, lawsuits under the False Claims Act have totaled 12,913, of which 8,489 were brought by whistleblower and returned $35.2 billion to the US Treasury, $4.9 billion in 2012. Healthcare fraud accounted for 5,527 of these suits and recovered $24.3 billion. The whistleblowers' share of these recoveries is $1,422,000,000. Small wonder that most cases under the Act are brought by disgruntled employees.
More than 80 percent of all successful False Claims Act recoveries are brought to the government by whistleblowers and their lawyers, making the law the most important tool the U.S. Government has in the war against fraud. However, it is important to recognize that the FCA is the most frequently used tool by federal prosecutors to enforce health care fraud and abuse laws.
The False Claims Act provides for triple damages plus statutory fines of up to $11,000 per false claim. Whistleblowers that bring evidence of fraud to the U.S. Government are eligible for awards of 15 to 30 percent of the total amount recovered under the Act. Many, if not most, of these actions are brought by disgruntled employees. Therefore, it is imperative that organizations have effective compliance programs to deal with these potential problems.
In this seminar you will learn how to identify these potential problems and to develop effective compliance programs to protect the organization and you.