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Fraud Enforcement Trends in the Health Care Industry Post COVID-19

Learn to properly recognize fraud and gain an understanding of enforcement trends in the health care industry.

Legal developments in enforcement in the health sector have been fast and furious over the past 12 months. Not only are federal and state law enforcement and regulatory authorities actively focusing on individuals and companies operating in the health care sector, they are increasingly relying on aggressive legal theories in their cases. From diverging interpretations of the Escobar materiality holding to novel application of the Travel Act, it is hard for practitioners to keep up in this fast-paced legal and enforcement environment. This topic, which is being led by two veteran health care enforcement defense attorneys, will summarize the most important developments in health care enforcement, both criminal and civil, over the past year and provide predictions for the future. Topics covered include hot cases brought by federal authorities, new federal charging theories and trends including EMR certification and managed care plan cases, health care investor/VC liability, trends in state attorney general enforcement, post-Escobar discovery and materiality rulings in federal court, the latest word in cooperation credit, the impact of the Granston Memo, and strategizing in a parallel investigation in light of the evolving enforcement landscape.

Runtime: 99 minutes
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Agenda

Latest Enforcement Trends

  • Key Government Enforcement Cases Over the Past 12 Months
  • Areas of Focus
    • PAPs
    • EMR Certification Compliance
    • Medicare Plans
    • Kickback Trends
    • Opioid
    • Genetic Testing
    • Use of the Travel Act and Other Statutes to Charge Kickbacks in Private Pay Context
  • Largest Settlements
  • Geographic Disparity in Charging Decisions
  • Increase in State Enforcement

Convincing DOJ to Dismiss the FCA Case

  • DOJ's New Willingness to Dismiss Cases
  • Has It Made a Difference?
  • How to Convince DOJ to Dismiss Your Client's FCA Case

Continued Importance of Materiality Issues

  • Materiality in Criminal Cases
    • Recent Acquittals and What They Tell Us
    • Jury Instructions
    • Discussion on How to Approach Materiality in Typical Health Care Fraud Criminal Matter
  • Materiality in Civil False Claims Act Cases
    • Escobar and Its Progeny
    • Impact on Motion Practice
    • Impact on Discovery Practice

Predicting the Future

  • What's Ahead for Criminal Enforcement?
  • What's Ahead for Civil Enforcement?

What Legal Counsel Should Focus on Now

  • Focusing on Materiality
  • The Self-Reporting Trick Bag
  • Cooperation in Light of the Granston Memo
  • Educating the Regulators

What Compliance Professionals Should Focus on

  • Examine EMR Certification and HITECH Compliance
  • Auditing Compliance With Existing AKS Restrictions
  • Assessing Exposure to Private Pay Kickback Allegations
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Credits

OnDemand Webinar

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Ohio, Oklahoma, South Carolina, and Wyoming CLE for this course. However, if you are interested in obtaining CLE for any of the listed states or have any additional credit questions please email us at [email protected] or call us at 866-352-9540.

This course was last revised on May 5, 2020.

Call 1-866-352-9540 for further credit information.

  • AHIMA 1.5 including Privacy & Security 1.5
     
  • This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.
     
  • AK CLE 1.5
     
  • Alaska attorneys may receive 1.5 hours of continuing legal education for completing this program. Please contact the Alaska Bar Association or go to www.alaskabar.org for details regarding reciprocity with other states.
     
  • AL CLE 1.7
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.7 hours credit.
     
  • AR CLE 1.5
     
  • This course has been approved for 1.5 hours of CLE by the Arkansas CLE Board.
     
  • Arizona CLE 1.5
     
  • The Arizona State Bar does not pre-approve or pre-certify MCLE programs. However, records of this program and attendance will be maintained by Lorman Education Services for auditing purposes. This activity may qualify for up to 1.5 hours toward your annual CLE requirement for the State Bar of Arizona.
     
  • CA MCLE 1.5
     
  • Lorman Business Center, LLC. is a State Bar of California approved MCLE sponsor and this course qualifies for 1.5 CLE hours of participatory credit.
     
  • CT CLE 1.5
     
  • Neither the Connecticut Judicial Branch nor the Commission on Minimum Continuing Legal Education approve or accredit CLE providers or activities. This course has been approved for CLE credit in jurisdictions aside from CT and therefore it automatically meets the content and delivery requirements in Connecticut. Credit is based on a 60 minute credit hour and shall be awarded as follows: 1.5 CLE credit(s).
     
  • HI CLE 1.5
     
  • This program was approved by the Hawaii State Board of Continuing Legal Education for 1.5 CLE credit hours.
     
  • IL CLE 1.5
     
  • This course was approved for a total of 1.5 hours of MCLE Credit by the Illinois MCLE Board.
     
  • ME CLE 1.5
     
  • This course has been approved by the State of Maine Board of Overseers of the Bar. Lawyers who complete this course shall receive 1.5 hours of CLE credit under M. Bar R. 12.
     
  • ND CLE 1.75
     
  • North Dakota CLE policy does not allow for pre-approval of any self-study courses. This course may qualify for up to 1.75 hours of CLE credit.
     
  • NH MCLE 1.7
     
  • NH MCLE does not approve or accredit CLE activities for the NH Minimum CLE requirement. Lorman Education Services believes this Ondemand course meets the requirement of NH Supreme Court Rule 53 and may qualify for CLE credit(s). Program Length: 99 Minutes.
     
  • NJ CLE 1.8
     
  • This program has been approved by the Board on Continuing Legal Education of the Supreme Court of New Jersey for 1.8 hours of total CLE credit.
     
  • NV CLE 1.5
     
  • This program has been approved by the Nevada Board of Continuing Legal Education for 1.5 CLE hours.
     
  • PA CLE 1.5
     
  • This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.5 hours of substantive law, practice and procedure CLE credit.
     
  • RI CLE 1.5
     
  • This program has been approved by the Rhode Island Mandatory Continuing Legal Education Commission for 1.5 hours of CLE credit.
     
  • VT CLE 1.5
     
  • This program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hours of self-study CLE credit.
     
  • WA CLE 1.75
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.75 hours of A/V credit under the Law & Legal Procedure category.
     
  • WI CLE 1.5
     
  • This program qualifies for 1.5 hour(s) of ondemand CLE through the WI Board of Bar Examiners.
     
  • WV MCLE 1.8
     
  • This program has been approved by the West Virginia State Bar MCLE Commission for 1.8 MCLE hours.
     

To earn each credit Lorman offers through the OnDemand learning platform, you need to watch 100% of the program. Also, for certain credits you will need to fulfill additional requirements which will be displayed on the "credits" tab when viewing the course.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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  • Arizona CLE 1.5
     
  • CA MCLE 1.5
     
  • CT CLE 1.5
     
  • HI CLE 1.5
     
  • ME CLE 1.5
     
  • NJ CLE 1.8
     
  • NV CLE 1.5
     
  • VT CLE 1.5
     
  • WA CLE 1.5
     
  • WV MCLE 1.8
     
The CLE Code is ONLY a requirement when applying for CLE Credit in California (for participatory credit), Kansas, New Jersey or New York. Other states do not need to supply the CLE Code to apply for CLE credit.

This program does NOT qualify, nor meet the National Standard for NASBA accreditation.

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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

Faculty

Carolyn McNiven

Carolyn McNiven

Greenberg Traurig, LLP

  • Shareholder with Greenberg Traurig, LLP
  • Focuses her practice on white-collar defense matters and related litigation
  • Has represented Fortune 50 companies, private companies, corporate executives and other individuals in a variety of delicate and challenging enforcement related matters
  • Regularly advises clients on civil enforcement exposure (including False Claims Act and whistle-blower/qui tam actions), and has frequently handled parallel investigations where there are both criminal and civil authorities involved
  • A former federal prosecutor for over 13 years, she served as deputy chief of the Financial Crimes and Special Prosecutions Section for the U.S. Attorney’s Office in Chicago and as that office’s criminal health care fraud coordinator
  • Has represented many businesses and individuals in the health sector, including pharmaceutical and medical device manufacturers, hospitals, retail pharmacy chains, substance use treatment centers, physicians and other health care professionals
  • J.D. degree, University of California at Berkeley School of Law; B.A. degree in fine arts, cum laude, Amherst College
Jessica Natali

Jessica Natali

Greenberg Traurig LLP

  • Shareholder with Greenberg Traurig, LLP
  • A white-collar criminal defense attorney and former assistant United States attorney for the Eastern District of Pennsylvania
  • Has deep experience both prosecuting and defending a wide range of criminal and civil cases, particularly health care fraud and narcotics cases involving doctors, pharmacists, and health care professionals
  • Specializes in federal and state grand jury investigations involving Medicare/Medicaid fraud; public corruption, election and campaign fraud, mail fraud, wire fraud, mortgage fraud, tax fraud, bankruptcy fraud, and money laundering, as well as assorted violent crime matters
  • Advised and worked closely with a variety of federal and local law enforcement agencies, including the Federal Bureau of Investigation, the Drug Enforcement Administration, the Internal Revenue Service, Homeland Security Investigations, the Bureau of Alcohol, Tobacco, Firearms and Explosives, the United States Department of Health and Human Services, the United States Postal Service, offices of attorneys general, police departments, and district attorney’s offices
  • Listed in The Legal 500 United States, Dispute Resolution - Corporate Investigations and White-Collar Criminal Defense, 2019
  • J.D. degree, summa cum laude, Temple University Beasley School of Law; B.S. degree, Drexel University
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Why Lorman?

Over 33 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.

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Product ID: 407413
Published 2020
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