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OnDemand Course

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.

99 minutes
Course Exam
Certificate of Completion
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Over 35 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 35 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 Course

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Maine, New Hampshire, 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.

  • ACFE 2.0
     
  • This program may qualify for 2.0 compliance or recertification CPE(s) through the Association of Certified Fraud Examiners (ACFE). Please visit the ACFE website for further clarification: https://www.acfe.com/maintaining-fields-of-study.aspx.
     
  • AR CLE 1.5
     
  • This course has been approved for 1.5 hours of CLE by the Arkansas CLE Board.
     
  • 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.
     
  • 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.
     

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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Why Lorman?

Over 35 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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Over 35 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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