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Protecting Against Health Care Fraud: Strategies, Tips and Tricks for Health Care Providers

Learn ways to manage health care fraud risk preemptively and during an investigation.

Healthcare providers have long faced significant risk from fraud enforcement investigations and actions due to the complex regulatory environment in which they operate. These risks have been compounded by the way the healthcare industry was changed by 2020 and the COVID-19 pandemic. This topic will explore the effects of 2020 on the healthcare industry and where it intersects with current and future fraud enforcement trends. The material will cover strategies for healthcare providers to help better position themselves to identify and respond to these risks in the current environment, both in terms of proactive compliance and in responding to investigations.

88 minutes
Course Exam
Certificate of Completion
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Why Lorman?

Over 34 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

The Way 2020 Changed the Healthcare Landscape

  • COVID-19 Impacts on Nature and Cost of Services
    • Heightened Safety Concerns, Staffing Issues, Materials Shortages
    • Restrictions on Elective Procedures and Financial Impacts
    • Increase in Digital Health and Telehealth
  • COVID-19 Reactive Regulations and Legislation
    • Prep Act
    • Cares Act
    • Cms and Oig Regulatory Waivers and Flexibilities
  • Other Regulatory Changes
    • Changes to AntiKickback Regulations by Hhs
    • Changes to Stark Law Regulations by Cms
  • Case Updates
    • Circuit Split Over FCA Liability for Differences of Clinical Opinion

Strategies for Managing Risk in the New Landscape

  • Keeping Abreast of Regulatory Changes
  • Importance of Robust Compliance Program and Employee Education
  • Role of Whistle-Blowers in Healthcare Fraud Enforcement
  • Addressing Cms Audits
  • Other Considerations
    • Using Big Data to Identify Risks

On the Enforcement Horizon

  • How Enforcement May Change in a Biden Administration
  • Hhs Creation of FCA Working Group With DOJ and Hhs-Oig
  • Continued Focus
    • Medicare Part C Billing (OneWay Reviews)
    • Kickbacks and Unlawful Marketing
    • Elder Fraud Initiative
  • New Focus
    • Cares Act and PPP Loan Risk
    • National Nursing Home Initiative
    • Electronic Health Records

Strategies for When an Investigation Hits

  • Responding to Subpoenas
  • Cooperation Credit Updates
  • Brand Memo Updates
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Why Lorman?

Over 34 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

MP3 Download

  • Arizona CLE 1.5
     
  • CA MCLE 1.5
     
  • HI CLE 1.25
     
  • NJ CLE 1.8
     
  • 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.

OnDemand Course

Applications have not yet been submitted for Delaware, Idaho, Kentucky, Maine, 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 February 16, 2021.

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

  • 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 1.5
     
  • This course or a portion thereof has been approved by the Alabama State Mandatory Continuing Legal Education Commission for a maximum of 1.5 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 1.0
     
  • 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: 1.0 CLE credit(s).
     
  • HI CLE 1.25
     
  • This program was approved by the Hawaii State Board of Continuing Legal Education for 1.25 CLE credit hours.
     
  • IL CLE 1.25
     
  • This course was approved for a total of 1.25 hours of MCLE Credit by the Illinois MCLE Board.
     
  • ND CLE 1.5
     
  • North Dakota CLE policy does not allow for pre-approval of any self-study courses. This course may qualify for up to 1.5 hours of CLE credit.
     
  • NH MCLE 1.5
     
  • 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: 88 Minutes.
     
  • PA CLE 1.0
     
  • This Distance Learning program has been approved by the Pennsylvania Continuing Legal Education Board for 1.0 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 self-study program has been approved by the Mandatory Continuing Legal Education Board of Vermont for 1.5 hour(s) of CLE credit. Please note: Attorneys may only claim 6 credits per compliance period in this format. This course is considered "Non-Moderated Programming without Interactivity".
     
  • WA CLE 1.5
     
  • This program has been approved by the Washington State Board of Continuing Legal Education for 1.5 hours of A/V credit under the Law & Legal Procedure category.
     
  • 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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Why Lorman?

Over 34 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

Meredith Auten

Meredith Auten

Morgan, Lewis & Bockius LLP

  • Partner in the office of Morgan, Lewis & Bockius LLP
  • Practice emphasizes all aspects of government and regulatory agency investigations and litigation involving alleged health care fraud, government contracts fraud, Foreign Corrupt Practices Act (FCPA), and business frauds
  • Conducts regular seminars and workshops on numerous white-collar litigation topics, in-cluding issues related to the FCA, internal investigations and opioids
  • Awards include Philadelphia Business Journal Best of the Bar, White Collar (2019); Who’s Who Legal Healthcare and Investigations (2020), Expert Guides, Expert, White Collar (2020)
  • Memberships: Vice President, Board of Trustees of the Philadelphia Bar Foundation; Na-tional Co-Chair, Criminal Justice Section White Collar Committee Qui Tam Subcommittee, American Bar Association; Vice Chair, Women's White Collar Defense Association, East Coast Region; Chair, Women's White Collar Defense Association, Philadelphia Chapter; Member, Trustees Council of Penn Women; Fellow, Litigation Counsel of America
  • University of Pennsylvania Law School
  • Can be contacted at 215-963-5860 or [email protected]
Kayla Kaplan

Kayla Kaplan

Morgan, Lewis & Bockius LLP

  • Senior associate in the Washington, DC office of Morgan, Lewis & Bockius LLP
  • Represents clients across all industries, including healthcare, in complex commercial liti-gation, internal and government investigations, and civil False Claims Act (FCA) cases
  • Regularly writes and speaks on civil FCA developments, including substantial contribu-tions to Wolters Kluwer's fifth edition of Civil False Claims and Qui Tam Actions.
  • Columbia Law School, James Kent Scholar
  • Can be contacted at 215-739-5736 or [email protected]
Kathleen McDermott

Kathleen McDermott

Morgan, Lewis & Bockius LLP

  • Partner in the Washington, D.C. office of Morgan, Lewis & Bockius LLP
  • Practice emphasizes healthcare industry enforcement and compliance matters. She has a national corporate defense practice in the health industry and is lead counsel in several government investigations and litigations related to violations of the False Claims Act and parallel criminal and administrative statutes. Served as an Assistant U.S. Attorney and DOJ health care fraud coordinator.
  • Active in teaching, publishing and speaking on health industry government enforcement and corporate compliance matters and serves as adjunct faculty at the University of Maryland Francis Cary School of Law, teaching the healthcare fraud seminar.
  • Awards include HHS-OIG Inspector General’s Integrity Award for her work in government health care fraud matters; National Litigation Star, White-Collar Crime/Enforcement/Investigations, Benchmark Litigation (2016–2018); Life Sciences Star, Non-IP Litigation and Enforcement, LMG Life Sciences (2016–2020); Life Sciences Star, Fraud and Abuse, LMG Life Sciences (2012–2016); Best Lawyers, Washingtonian magazine (2007–2019); Recognized, White Collar Matters, Washington, DC Corporate Counsel Super Lawyers; Recognized, Health Care and Criminal Defense: White Collar, Washington, DC Super Lawyers (2007–2009, 2014–2020)
  • Membership information includes Advisory Board of the Bloomberg BNA Medical Device Industry Publication; Chair of the Federal Bar Association Health Law Section; member of the Women’s White Collar Defense Association; Co-Chair, White Collar Crime False Claims Act Subcommittee of the American Bar Association; Chair, American Health Lawyers Association Fraud and Abuse Practice Group and Program Committee for Annual Fraud and Compliance Forum; Chair, Litigation Section of the Maryland State Bar Association; Fellow, Maryland Bar Foundation; Fellow, American Bar Association Foundation
  • J.D. degree, cum laude, Suffolk University Law School
  • Can be contacted at 202-739-5458 or [email protected]
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Why Lorman?

Over 34 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: 400514
Published 2021
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