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Product Id : 20062PACK

Overview: This webinar will discuss the Health Care Quality Improvement Act (HCQIA) in detail, including the standards that must be met to achieve immunity under the act. The HCQIA itself will be reviewed, including a detailed look at the Congressional purpose for the act. The legislative history of the act will be reviewed to gain an understanding of the intent of Congress in passing the act.

Next will be a review of the standards under the act. We will conduct a detailed review of each of the standards and the actions that are required to meet the intent of the standards. Specifically, there are four standards under the act that must be met. We will review each of these with an eye toward court interpretation of what actions an organization must take to achieve the protections granted by the act.

First, the action must be taken "in the reasonable belief that the action was in the furtherance of quality health care." We will examine what this means and what is required for the entity taking the action to have a "reasonable belief."

Second, the action must be taken "after a reasonable effort to obtain the facts of the matter." The webinar will discuss in some depth what is required to conduct an adequate investigation. Before any definitive action is taken, there must be an adequate investigation to determine the facts of the matter. This seems like simple common sense, but one would be surprised at how often the investigation is found to be less than what is expected. The focus of this portion of the webinar is to review what constitutes an adequate investigation, particularly one that will withstand the scrutiny of the court when the hospital or other professional review body is asking for immunity under the Health Care Quality Improvement Act (HCQIA).

Third, the action must be taken, "after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances." The act sets forth the "safe harbor" conditions that a health care entity must meet regarding adequate notice and hearing procedures. We will examine these safe harbor conditions and discuss in detail what must be done to achieve immunity under this standard. In addition, we will discuss what actions must be taken when a practitioner asks for a hearing but it is not possible to provide one.

Fourth, the action must be taken, "in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the [notice and hearing] requirement." While the analysis of this standard generally tracts the analysis of the first standard, "in the reasonable belief," there is considerable interpretation by the courts of exactly what this standard means and what must be done to accomplish it. We will review that court review and analyze the actions required to meet it.

We will also review cases that discuss the situation where the peer review committee reached incorrect conclusions, and the implications that such a conclusion has for immunity under the act.

Why should you attend: You should attend this webinar to gain an understanding of how the HCQIA protects your organization and those who participate in the peer review process in your organization, as well as gain an appreciation of the actions that are required to perfect the HCQIA immunity. Failure to take the appropriate actions and to follow the correct protocol can result in a disastrous situation.

You will learn how to facilitate the frank exchange of information among professionals conducting peer review inquiries without the fear of reprisals in civil lawsuits. The statute attempts to balance the chilling effect of litigation on peer review with concerns for protecting physicians improperly subjected to disciplinary action; accordingly, Congress granted immunity from monetary damages to participants in properly conducted peer review proceedings while preserving causes of action for injunctive or declaratory relief for aggrieved physicians. Not only will you gain an understanding of the immunity provisions, you will gain an appreciation of the standards that professional review actions must satisfy to entitle the participants to such protection.

We will discuss what is required to provide a "fair" hearing, including the actions that must be taken before and during the hearing process. You will gain an understanding of how to conduct an investigation of the allegations that form the basis of the professional review action and the standards that the courts review to ensure that the investigation was adequate. You will learn how the courts interpret the mandate in the HCQIA that the action was taken "in the reasonable belief that the action was in the furtherance of quality health care." You will also gain an understanding of what is required to meet the standard, "after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances."

Areas Covered in the Session:
  • The Health Care Quality Improvement Act
  • Legislative history of the Health Care Quality Improvement Act and the intent of Congress
  • Immunity under the Health Care Quality Improvement Act
  • Standards required to achieve immunity under the Health Care Quality Improvement Act
  • Review of the Health Care Quality Improvement Act by the courts

Who Will Benefit:
  • Hospital Executives
  • Medical Staff Officers
  • Physicians who serve on Peer Review Committees
  • Medical Staff
  • Support Staff
  • Attorneys Representing Hospitals
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
Product Id : 20062PACK

Overview: Because the Anti-Kickback Statute is so broad it what it proscribes, healthcare organizations, conducting what would be normal marketing activities in other industries, have run afoul of the Statute on numerous occasions. The Statute and the regulations only tell part of the story.

This program will review not only the Statute and its safe harbors, but will provide an in-depth overview of OIG guidance and advisory opinions dealing with marketing activities, as well as a review of case law regarding marketing behavior.

Why should you attend: If your organization, be it a hospital, physician practice, DME provider, or any other provider offering healthcare services or supplies, engages in marketing its product or services, care must be taken to ensure that the organization does not run afoul of the Anti-Kickback Statute. This program will review not only the Statute itself, and the safe harbors, but will also critique the case law, OIG advisory opinions, and OIG compliance guidance to help you understand what you can and cannot do with engaging in healthcare marketing.

When you finish this program, you should have a good understanding of what you can and cannot do with regard to marketing activities. The penalties for not conducting a marketing program correctly can be severe, including exclusion, civil monetary penalties and even criminal prosecution.

Areas Covered in the Session:

  • A brief review of the Anti-Kickback Statute, what it is and what is prohibited
  • A brief review of the safe harbors that relate to marketing activities
  • A review of the OIG advisory opinions as they relate to marketing
  • A review of OIG compliance guidance as it relates to marketing
  • An overview of case law relating to marketing activities
  • Strategies that should be taken to preclude liability

Who Will Benefit:
  • Hospital Executives
  • Physicians, including Dentists, Podiatrists and Chiropractors
  • Physician Practice Executives
  • DME Provider Executives
  • Ancillary Service Providers
  • Ancillary Service Provider Executives
  • Attorneys representing any and all of the above
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
Product Id : 20062PACK

Overview: The program will provide an overview of the Federal Civil False Claims Act (FCA), including how to determine if you have a viable whistleblower suit. We will discuss what type of evidence you need to have to proceed with the suit.

The program will take the FCA and show step by step how an action is filed, how the government responds and how the courts interpret various elements of the FCA. We will discuss proof, damages under the FCA and how a whistleblower is rewarded for bringing a successful case. Retaliation will be discussed, along with and how the whistleblower is protected from retaliation under the FCA.

We will discuss the theories of false certification and show how violation of the anti-kickback statute and/or physician referral laws (Stark II) can constitute false claims. Since the government relies on compliance with these laws for payment, violations serve as the basis of a FCA suit.

Why should you attend: Several recent cases involving healthcare providers have resulted in huge settlements. If you believe that you have a potential whistleblower lawsuit that can be filed under the False Claims Act, you should attend this webinar to explore your alternatives. You may be setting on a gold mine and you should examine how viable you potential case is. This webinar will provide you with the tools to evaluate your case with a view to discussing it with an attorney who practices in the False Claim Act arena.

Areas Covered in the Session:
  • The Federal False Claims Act and how the Act works
  • Rewards to whistleblowers
  • Proof
  • Damages
  • Risks of filing a whistleblower suit
  • False claims, Stark and Anti-kickback
  • How the case proceeds
  • Why prosecuting a whistleblower case can be difficult
  • Legal representation
  • Awards
  • Downsides

Who Will Benefit:
  • Hospital Employees
  • Executives and Department Managers
  • Nursing Home Employees and Executives
  • Physicians
  • Physician Practice Managers
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
Product Id : 20062PACK

Overview: Most disciplinary policies are progressive. A progressive policy applies increasingly more severe sanctions to additional incidents of bad behavior. It is very important that the organized medical staff have a disruptive practitioner policy. This webinar will discuss the development of such a policy, including what it should include, and how it should be implemented.

It is also important to understand what constitutes disruptive behavior. Disruptive behavior includes violent or verbally abusive activity, but it is not limited to such behavior. This webinar with review several actual examples of disruptive behavior that has been the subject of action brought in court.

Disruptive activity takes many forms. Understanding that, this webinar will discuss the steps that the hospital and/or the medical staff should take to see that it does not affect patient care or disrupt operations.

Many times, the medical staff management simply condones the problem of the disruptive practitioner until it gets to a point where it can no longer be ignored. However, if the steps outlined in this webinar are taken, there will be ample evidence that this is a continuing problem and the staff has made every effort to correct it without resorting to an adverse action. This procedure also provides documentation that the medical executive committee took the adverse action based on a substantial factual basis and that its action was not arbitrary, unreasonable or capricious.

Why should you attend: Hospital executives, medical staff officers, and peer review committee members and support staff should attend to learn how to deal effectively with the disruptive practitioner. You will also learn how to prepare for the day when it becomes necessary to terminate such a practitioner's privileges and medical staff membership.

You will also gain an understanding of how to develop provisions in the medical staff bylaws to deal with the disruptive practitioner and how to develop a clear and concise policy regarding disruptive behavior. We will discuss the elements of an effective policy and the actions that should be taken to develop progressive discipline and/or sanctions that should be taken before taking action under the corrective action procedures.

It is very important to demonstrate that this disruptive behavior is a continuing problem; therefore, appropriate documentation is imperative. You will discover how to create a record of this continuing problem and the efforts taken by the organization to combat the problem.

Areas Covered in the Session:
  • Disruptive practitioner policies
  • Corrective action procedures
  • What constitutes disruptive behavior?
  • Steps the hospital and/or the medical staff should take to see that the disruptive activity does not affect patient care or disrupt operations

Who Will Benefit:
  • Hospital Executives
  • Medical Staff Officers
  • Physicians who serve on peer review committees
  • Medical Staff Support Staff
  • Attorneys Representing Medical Staffs
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
Product Id : 20062PACK

Overview: This webinar will discuss the Health Care Quality Improvement Act (HCQIA) in detail, including the standards that must be met to achieve immunity under the act. The HCQIA itself will be reviewed, including a detailed look at the Congressional purpose for the act. The legislative history of the act will be reviewed to gain an understanding of the intent of Congress in passing the act.

Next will be a review of the standards under the act. We will conduct a detailed review of each of the standards and the actions that are required to meet the intent of the standards. Specifically, there are four standards under the act that must be met. We will review each of these with an eye toward court interpretation of what actions an organization must take to achieve the protections granted by the act.

First, the action must be taken "in the reasonable belief that the action was in the furtherance of quality health care." We will examine what this means and what is required for the entity taking the action to have a "reasonable belief."

Second, the action must be taken "after a reasonable effort to obtain the facts of the matter." The webinar will discuss in some depth what is required to conduct an adequate investigation. Before any definitive action is taken, there must be an adequate investigation to determine the facts of the matter. This seems like simple common sense, but one would be surprised at how often the investigation is found to be less than what is expected. The focus of this portion of the webinar is to review what constitutes an adequate investigation, particularly one that will withstand the scrutiny of the court when the hospital or other professional review body is asking for immunity under the Health Care Quality Improvement Act (HCQIA).

Third, the action must be taken, "after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances." The act sets forth the "safe harbor" conditions that a health care entity must meet regarding adequate notice and hearing procedures. We will examine these safe harbor conditions and discuss in detail what must be done to achieve immunity under this standard. In addition, we will discuss what actions must be taken when a practitioner asks for a hearing but it is not possible to provide one.

Fourth, the action must be taken, "in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the [notice and hearing] requirement." While the analysis of this standard generally tracts the analysis of the first standard, "in the reasonable belief," there is considerable interpretation by the courts of exactly what this standard means and what must be done to accomplish it. We will review that court review and analyze the actions required to meet it.

We will also review cases that discuss the situation where the peer review committee reached incorrect conclusions, and the implications that such a conclusion has for immunity under the act.

Why should you attend: You should attend this webinar to gain an understanding of how the HCQIA protects your organization and those who participate in the peer review process in your organization, as well as gain an appreciation of the actions that are required to perfect the HCQIA immunity. Failure to take the appropriate actions and to follow the correct protocol can result in a disastrous situation.

You will learn how to facilitate the frank exchange of information among professionals conducting peer review inquiries without the fear of reprisals in civil lawsuits. The statute attempts to balance the chilling effect of litigation on peer review with concerns for protecting physicians improperly subjected to disciplinary action; accordingly, Congress granted immunity from monetary damages to participants in properly conducted peer review proceedings while preserving causes of action for injunctive or declaratory relief for aggrieved physicians. Not only will you gain an understanding of the immunity provisions, you will gain an appreciation of the standards that professional review actions must satisfy to entitle the participants to such protection.

We will discuss what is required to provide a "fair" hearing, including the actions that must be taken before and during the hearing process. You will gain an understanding of how to conduct an investigation of the allegations that form the basis of the professional review action and the standards that the courts review to ensure that the investigation was adequate. You will learn how the courts interpret the mandate in the HCQIA that the action was taken "in the reasonable belief that the action was in the furtherance of quality health care." You will also gain an understanding of what is required to meet the standard, "after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances."

Areas Covered in the Session:
  • The Health Care Quality Improvement Act
  • Legislative history of the Health Care Quality Improvement Act and the intent of Congress
  • Immunity under the Health Care Quality Improvement Act
  • Standards required to achieve immunity under the Health Care Quality Improvement Act
  • Review of the Health Care Quality Improvement Act by the courts

Who Will Benefit:
  • Hospital Executives
  • Medical Staff Officers
  • Physicians who serve on Peer Review Committees
  • Medical Staff
  • Support Staff
  • Attorneys Representing Hospitals
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.
Product Id : 20062PACK

Overview: The session will provide an overview of medical necessity, particularly for the point of view of billing medical necessity as opposed to clinical medical necessity. We will address what providers and hospitals can do to try to stem this enforcement effort and how compliance programs should be adapted to address this risk area. We will address how historic fraud and abuse detection efforts are changing and review what the future holds for fraud detection and enforcement.

We will discuss how companies/hospitals should self assess medical necessity activity. We will address who is accountable for the medical decisions of physicians and what should be done to fulfill that responsibility. We will provide insight into measurement tools that allow hospitals to evaluate and/or challenge the medical decisions of the medical staff. We will also discuss how hospitals can self assess medical necessity activity. The roll of peer review and due diligence reviews will be reviewed.Finally, the webinar will review some of the high-profile cases and how the government is approaching its enforcement activities.

Why should you attend: This session is designed for health care executives, physicians and other health care providers who participate in and receive remuneration from Medicare, Medicaid, and other federal health care programs such as TriCare. Several recent actions bring home the realization that medical necessity is an enforcement target and compliance focus should be a priority.

As a health care executive, physician or other health care provider, you should be very concerned about the potential for the government to use medical necessity as a basis to pursue a federal False Claims Act action to stem the tide of overutilization of Medicare, Medicaid, TriCare and other government healthcare services. Three cases in particular, involving spinal surgery, have occurred in the past year. In at least one of those cases, the surgeon has apparently left the country for his native Pakistan. Attend this webinar and learn how to protect yourself and your organization.

Areas Covered in the Session:
  • Medical necessity: clinical vs billing necessity
  • How compliance programs can be adapted to address this risk area
  • Enforcement activities involving medical necessity
  • Self assessment
  • Accountability for medical decisions
  • Measurement tools
  • The roll of peer review
  • High-profile cases

Who Will Benefit:
  • CEOs
  • COOs
  • CNOs
  • CMOs
  • Medical Staff Officers
  • Physicians
  • Physicians who serve on peer review committees
  • Medical Staff
  • Support Staff
  • Attorneys representing Medical Staffs
William Mack Copeland MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics.

Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.