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Medical Fraud or Medical Necessity: Documenting Your Story


Gain an understanding of medical necessity and the importance of correct documentation.

The difference between the government making a determination of medical fraud as opposed to medical necessity lies in your documentation. Physicians, hospitals, labs, long-term care providers, and all other medical providers must properly document that their services were medically necessary. This course will inform providers, compliance professionals, and billers of the meaning and interpretation of the term medical necessity. The course will also provide guidance for properly documenting the procedures and services performed. To better understand the impact of proper documentation of medical necessity, this material will focus on recent government prosecutions and settlements, particularly in areas of increased government focus, such as telehealth services. Gain practical tips and considerations for documenting medical necessity.



Kirti V. Reddy

Kirti V. Reddy

Quarles & Brady

  • Partner, Healthcare Law Group, Quarles & Brady LLP
  • Extensive experience in government investigations and federal civil litigation
  • Advises on fraud and abuse matters and conducts internal investigations and risk assessments
  • Former Assistant United States Attorney for the Southern District of New York, Civil Division
  • Previously lead counsel for the government on a number of investigations and prosecutions involving health care matters
  • Executive Office for the United States Attorney’s Director’s Award, Superior Performance for investigation and litigation of a matter based on the False Claims Act, 201
  • Adjunct Professor, Seton Hall Law School
Theresa DeAngelis

Theresa DeAngelis

Quarles & Brady

  • Associate, Healthcare Law Group, Quarles & Brady LLP
  • Advises health care industry clients on a wide range of regulatory, transactional, and litigation matters, with a primary focus on fraud and abuse compliance and litigation
  • Experience in government investigations
  • Previously represented qui tam relators under federal and state False Claims Acts in health care matters, both in cases in which the government elected to intervene and cases in which the government declined to intervene
  • Master’s degree in health administration

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