Distance Learning Center

Educating and Connecting the Health Law Community.

Fraud and Abuse

  • Medicare Advantage Risk Adjustment: Legal Issues for MA Plans, Providers, and Vendors

    Contains 4 Component(s), Includes Credits Includes a Live Web Event on 06/25/2020 at 2:00 PM (EDT)

    The topic will be Medicare Advantage risk adjustment legal risks and compliance strategies.

  • Fraud and Abuse in the Age of Coronavirus: Current and Future Federal Criminal and Civil Enforcement Actions

    Contains 4 Component(s), Includes Credits Includes a Live Web Event on 06/10/2020 at 2:00 PM (EDT)

    The Federal government stimulus in response to the Coronavirus pandemic will lead to a significant flow of federal money to many industries, including health care. We know from past federal stimulus efforts that the risk of fraud and abuse is high, and the federal government is taking proactive measures to combat fraud and abuse resulting from the Coronavirus pandemic response. At the same time, the regulations concerning the stimulus money and guidance related to the Stark blanket waivers and other regulatory guidance is evolving and open to interpretation. Our speakers will cover the potential criminal and civil exposures, the ongoing government response to monitor and pursue fraud and abuse, and guidance for health care entities who are working in this quickly changing regulatory environment. The panel will also discuss DOJ's focus on investigating and prosecuting efforts to take advantage of the pandemic by selling fraudulent services and treatments.

  • Deploying Resources to Drive Value-Based Care: Potential Opportunities and Stumbling Blocks in Light of Stark/AKS Proposals

    Contains 4 Component(s), Includes Credits Includes a Live Web Event on 06/02/2020 at 2:00 PM (EDT)

    Over the last decade, Accountable Care Organizations (ACOs) have moved from experimental pilot programs to established parts of the health care industry. ACOs and closely related Clinically Integrated Networks (CINs) are now core parts of the market strategy for many providers and payers. But as ACOs and CINs become more established, compliance risks may emerge as well. This webinar will cover common operational compliance considerations for ACOs and CINs, as well as explore some of the potential emerging legal risks that in-house counsel and compliance staff should understand as more organizations embrace the ACO model.

  • Significant False Claims Act Case Law Developments and Preparing for FCA Enforcement in the Post-COVID-19 World - On Demand Recording

    Contains 1 Component(s) Recorded On: 05/27/2020

    The FCA is the federal government’s primary weapon to combat allegations of fraud and abuse in its programs. This presentation will cover two areas. One is to address significant new trends that have emerged regarding FCA enforcement, such as how circuit courts have split regarding whether reasonable clinical judgment can form the basis of an FCA action, whether claims can be materially false if the government does not routinely seek repayment through administrative action, and when violations of the Anti-Kickback law and Stark law can constitute a violation of the FCA. A second area is to address the likely enforcement actions the government or qui tam relators will undertake stemming from government funding related to the COVID-19 and steps healthcare entities can undertake to reduce exposure to liability.​

  • Impact of Proposed Stark Law Changes on Existing Exceptions and New Blanket Waivers - On Demand Recording

    Contains 1 Component(s) Recorded On: 04/30/2020

    This webinar will discuss CMS’ blanket Stark waivers that enable a fuller response to the Coronavirus Pandemic and the practical application of the Stark Blanket waivers, unanswered questions, and the potential fraud and abuse concerns in typical business transactions. In addition, the panel will address the SPRINT’s proposed changes to established exceptions and their impact on clients.

  • Lessons Learned from a CIA: From Implementation through Exit - On Demand Recording

    Contains 1 Component(s) Recorded On: 04/23/2020

    Webinar will contain practical advice on how to survive a quality of care CIA from both the legal and operational perspective. The webinar will provide practical guidance on how to approach each stage of the CIA process, from negotiation to implementation and operation to eventual exit. The critical role of data monitoring and root cause analysis will be discussed, along with suggestions for how to build a culture of compliance throughout an organization.

  • Potential Operational Implications of the Stark Law Proposed Rule for Health Care Entities - On Demand Recording

    Contains 1 Component(s) Recorded On: 03/26/2020

    Stark Law, group practice profit distributions, potential regulatory modifications, practical implications of proposed regulatory flexibility.

  • The Opioid Crisis and Compliance - On Demand Recording

    Contains 1 Component(s) Recorded On: 03/12/2020

    This session will provide an in-depth look in how to effectively manage the risks of the opioid epidemic through compliance efforts. Session Objectives: Compliance Requirements and Beyond - Evaluating the effectiveness of your compliance program and remedial efforts to implement or improve one in the face of the opioid epidemic. Systems Controls - Addressing which buttons and levers can be pulled and protected to achieve 100% compliance for each team of stakeholders while retaining individual decision-making authority of the clinicians. Response Plan - Implementing a response plan in a multidisciplinary project plan to address vulnerabilities and improve the coordinate response of the Compliance Program.

  • Physician Practices: Strategies for Remaining Independent - On Demand Recording

    Contains 1 Component(s) Recorded On: 03/05/2020

    Physician practices are struggling to maintain their independence, with many opting to sell their practices to private equity or health systems. For those wishing to maintain their independence, it is critically important that they understand opportunities for growth, successful partnerships and joint ventures, and that they know how to maximize and maintain the value of their key assets (physician, patients, and data). This webinar will describe several innovative business models and strategies for physicians to maintain their independence. Attendees will also receive sample provisions and checklists to help them advise their clients on these models and legal issues associated therewith.

  • Federal False Claims Act: A Year in Review - On Demand Recording

    Contains 1 Component(s) Recorded On: 02/27/2020

    Federal False Claims Act recoveries remained at an all-time high in 2019 as the United States government continues the fight against fraud. Last year saw a slew of new case law and announcements from the DOJ and some new enforcement priorities. “A Year in Review” will update you on the current regulatory enforcement environment, including: • Important regulatory, compliance, and enforcement activity during 2019 • Noteworthy settlements and lessons learned over the past year • Continuing developments with the Stark Law, the Anti-Kickback Statute, and the False Claims Act • Proactive compliance activities to protect your organization in 2020 and beyond

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