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Health Care Fraud  

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Seminar Summary:

This seminar will be a detailed analysis of the rapidly expanding area of Health Care Fraud investigation and prosecution on both the State and Federal level. (see full course description)

 
 

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Training Course Syllabus:


This seminar is designed for attorneys, business and office managers, health care providers, billing managers, compliance officers, CEOs, administrators and accountants.

This seminar will be a detailed analysis of the rapidly expanding area of Health Care Fraud investigation and prosecution on both the State and Federal level. The faculty will address the subject areas in a panel format in order to provide a balanced, practical presentation. The faculty includes State and Federal prosecutors charged with enforcement as well as experienced defense counsel who concentrate in the subject area.

This program is designed to benefit everyone who toils in the vineyard of Medicare and Medicaid or represents health care providers. Litigators, in-house counsel, compliance counsel and program administrators would all benefit from the presentation and discussions. Physicians and other health care providers concerned about the grave ramifications of fraud investigations would receive valuable guidance in how to respond to audits, subpoenas, search warrants and other government demands. A timely ethics presentation will address the complex area of work-product privilege and government demands for waiver.

8:30 a.m. - 9:40 a.m.

I. Health Care Fraud Overview

A. Federal – Applicable Statutes And Case Law, i.e…FCA, Stark, Kickbacks, Mail Fraud. Targeted Areas Of Health Industry. Legislative Directives And Funding

B. State – Applicable Statutes And Case Law, i.e…. Abuse And Neglect, Quality Of Care. Targets. Long Term Care, Staffing, Injury And Death Cases.

C. Defense – Pre-Investigation Compliance And Education Of Clients. Self Reporting. Addressing Contract, Billing, Staffing And Human Resource Issues In Advance Of Problems.

9:40 a.m. - 9:50 a.m.

Break

9:50 a.m. - 11:00 a.m.

II. Investigations

A. Federal – Grand Jury Subpoenas, AIDS, OIG Subpoenas, Civil Investigative Demands, Search Warrants. Utilization Of These And What Government Views As Mandatory Level Of Cooperation

B. State – MFCU And Other Investigative Agencies. Surveys, Use Of Local Law Enforcement. Search Warrants And Subpoenas. Noncompliance Remedies. Scope And Breadth Of Jurisdiction. Targets, Subjects Et Al.

C. Defense – Internal Investigations. Handling The Audit That Becomes The “Silver Platter” For Criminal Prosecution Inside/Outside Counsel. Representation Of Client’s Employees. Self Reporting. Response To Subpoenas, Production Demands, Search Warrants.

11:00 a.m. - 12:00 p.m.

III. Negotiation, Charging Decisions, Motion Practice, Trial

Panel Discussion Of Above Focusing On Practical Strategies, Use Of Corporate Integrity Agreements, Global vs. Individual Issue Resolution, Discovery Issues, Use Of Experts Trial Preparation.

12:00 p.m. - 1:00 p.m.

Lunch (On Your Own)

1:00 p.m. - 2:10 p.m.

IV. Civil FCA

A. Explanation Of Law And Scope…Situations In Which It’s Likely To Be Utilized. Relationship To Parallel Or Pending Criminal Case. Certification As Prosecution Theory. Knowledge Element. Defense/Prosecution Approach To Civil FCA Negotiation.

2:10 p.m. - 2:20 p.m.

Break

2:20 p.m. - 3:20 p.m.

V. Ethical Considerations

A. Waiver Of Work Product And Other Privileges, Multiple Representation Conflicts, Thornburg/Holder/Thompson Memos, Self Reporting.

3:20 p.m. - 4:30 p.m.

VI. Ancillary Areas “Ripple Effects” Even If No Charges

A. State And Federal Audits, Administrative Appeals, State Withholding Orders, OIG Exclusion, HCFA And PRO Audits, Licensing Consequences, Suspensions, Revocations And Conditions.

Seminar Summary:

This seminar will be a detailed analysis of the rapidly expanding area of Health Care Fraud investigation and prosecution on both the State and Federal level. (see full course description)

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