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The Stark Rule, Anti-Kickback Statue, False Claims Act and Medicare Secondary Payer Rule
- Federal False Claims Act (what it is and how it works)
- How the FCA is being used as an enforcement tool by the federal enforcement authorities
- Federal Civil Anti-Kickback Statute
- Safe Harbors providing protection under the AKS
- Enforcement activities involving the AKS
- Recommendations to mitigate violations of the AKS
- The Medicare Secondary Payor Rule
Overview of the webinar
The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works. It will also provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will start with a review of the Federal False Claims Act and discuss how it works and how it is being used to fight health care fraud. We will discuss how the various health care fraud task forces use the Federal False Claims Act and its whistleblower provisions to identify and prosecute health care fraud. The webinar will take the Federal False Claims Act apart and show step by step how an action is filed, how the government responds and how the courts interpret various elements of the Act. We will discuss proof, damages under the Act and how the whistleblower is rewarded for bringing a successful case.
The session will also provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as a general review the AKS available safe harbors. It will also show how violation of the AKS can raise FCA concerns and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants. We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law. The webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it.
Finally, we will review the Medicare Secondary Payor Rule and its implications for hospitals.
Who should attend?
- Hospital Executives, particularly CEOs, COOs, CFOs, CNOs and CMOs
- Nursing Home Executives
- Physicians
- Physician Practice Managers
- Other Healthcare Provider Executives
Why should you attend?
This session is designed for health care executives, physicians and other health care providers who participate in and receive remuneration from Medicare, Medicaid, and other federal health care programs such as TriCare. As a health care executive, physician or other health care provider, you should be very concerned about the potential for enforcement actions under the Federal False Claims Act. This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced. Recovery under the Federal False Claims Act in 2015 resulted in over $4.9 billion being recovered for the federal government, $24.2 billion since the law was revised to make it more relator friendly in 1986.
Since 1986, whistleblowers have been awarded nearly $4 billion, with $439 million in awards in the fiscal year 2012. And whistleblowers are where a majority of the Federal False Claims Act suits originate. Several recent cases involving healthcare providers have resulted in huge settlements. If that is not enough to get your attention, consider the recent cases finding that the “responsible corporate officer doctrine” allows the government to hold hospital CEOs and others directly responsible for the fraud.
In addition, several recent cases bring home the realization that the Anti-Kickback Statute is alive, still with us and as viable as ever, and it makes activities that are common in other industries a crime. As a health care executive, physician or other health care provider, you should be very concerned about the potential for the government to use the Anti-Kickback Statute as one of the prime methods for enforcing the FCA, the primary enforcement tool used by the Justice Department.
It is also concerning that, along with Stark II (The Federal Physician Anti-Referral Law), the Anti-Kickback Statute can be and is being used as the basis for an action brought under the FCA. In this webinar, you will learn about the elements of the Anti-Kickback Statute, along with a general discussion of the various exceptions and safe harbors that you can rely on for protection against enforcement under these laws. This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced. In addition, the Affordable Care Act (better known as Obamacare), the government has greatly enhanced enforcement resources.
Three cases, The Christ Hospital case in Cincinnati, with a settlement in excess of $100 million, Tuomey Healthcare, with a verdict of 237.5 million, which was settled for $72.4 million but whose CEO was assessed a personal fine of one million dollars, and the Hardeman Memorial Hospital case in Texas, with a settlement of $398, 230.56 stand out. In the Hardeman case, the Texas federal court sentenced former CEO Angela Edwards to 2 ½ years in prison and ordered her to pay $370,657 in restitution. If that is not enough to get your attention, consider the recent cases finding that the “responsible corporate officer doctrine” allows the government to hold hospital CEOs and others directly responsible for the fraud.
You will want to attend this webinar to learn how to protect yourself and your organization.
Faculty - Mr.William Mack Copeland
William Mack Copeland, MS, JD, PhD, LFACHE, practices health care law in Harrison, Ohio at the firm of Copeland Law, LLC. He is also president of Executive & Managerial Development Group, a consulting entity providing compliance and other fraud and abuse related services. A graduate of Northern Kentucky University Salmon P. Chase College of Law, Bill is a frequent author and speaker on health law topics. Copeland is a member of the American Health Lawyers Association, American, Ohio and Cincinnati Bar Associations and is a life fellow in the American College of Healthcare Executives. He was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007. He can be reached at (513) 290-2458 or wmc@copeland-law-llc.com.