The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works, the prohibitions of the Anti-Kickback Statute (AKS) and the physician anti-referral law (known as Stark II), and their available safe harbors. It will also show how violation of the AKS and/or Stark II 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 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. In addition, we will discuss retaliation under the act and how the whistleblower is protected from retaliation. Finally, with regard to the Federal False Claims Act, we will discuss how the Act is being used in the health care arena.
In addition, we will discuss the OIG’s Joint Venture Advisory Opinion, where a hospital expands into a related service line by contracting with an existing provider of that service. The OIG has significant problems with such an arrangement. We will also discuss the recent advisory opinion by the OIG regarding Physician-Owned Entities. OIG views PODs as inherently suspect under the AKS because the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the AKS.
The focus will then turn to Stark II, with an emphasis on the exceptions and how to fit within and exception. While there are several exceptions, it is important to be able to meet the criteria of an exception. We will discuss these criteria, and the nuances that must be met.
Why should you attend: This session is designed for healthcare executives, physicians and other healthcare providers who participate in and receive remuneration from Medicare, Medicaid, and other federal healthcare programs such as TriCare. The session will provide an overview of the FCA and how it works, the prohibitions of AKS and Stark II, and their available safe harbors. It will also show how violation of the AKS and/or Stark II can raise FCA concerns. In addition, it will provide an assessment of enforcement activities, showing how participants may be at risk. Finally, the session will review recent cases and show how they potentially impact participants.
Areas Covered in the Session: