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Handouts - 2018 - National - Enforcement

Healthcare Enforcement Compliance Conference
November 4 - 7, 2018 | Washington DC

 

Sunday, October 29 ( Pre-Conference)

P1 Anatomy of False Claims Act Case

Moderator: Katherine Lauer, Partner, Latham & Watkins, LLP
Amy Easton, Phillips and Cohen LLP
Laura Ellis, Senior Counsel, HHS OIG
Amy D. Kossak, Trial Attorney, Fraud Section, Civil Division, U.S. DOJ

  • The Investigation Phase: subpoenas/ CIDs, data analysis, witness interviews and more
  • The Negotiation Phase: initiation, ADR, scope of release, monetary and other issues
  • The Resolution Phase: settlement agreements, individual liability, CIAs/ OIG and relator issues

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P2 A Data Breach Lived and Learned: Practical Tips for Your Response and HHS OCR’s Review

Lisa S. Rivera, Partner, Bass, Berry & Sims PLC
John M. Bailey, HIPAA Privacy Officer, St Jude Children’s Research Hospital

  • Assessing your current breach response team and plan
  • Learn from others’ (or your own) mistakes—some current issues and resulting actions, both by the government and in privacy suits
  • Know HHS OCR’s perspective before, during and after a breach

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P3 2018 OIG Administrative Enforcement Update

David M. Blank, Partner, Quarles & Brady LLP
Mariel Filtz, Program Analyst, HHS OIG

  • Overview of the OIG’s enforcement priorities for 2018 and beyond
  • Discussion of recent OIG civil monetary penalties resolutions
  • The impact of OIG’s enforcement on providers and how to implement the most effective compliance measures to address the OIG’s enforcement priorities

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P4 Litigating a False Claims Act Case

John T. Boese, Of Counsel, Fried, Frank, Harris, Shriver & Jacobson LLP
Robert Vogel, Partner, Vogel, Slade & Goldstein
Latour “LT” Lafferty, Partner, Holland & Knight
Ben Wei, Senior Trial Counsel, Fraud Section, Civil Division, U.S. DOJ

  • Common motions in FCA litigation
  • Proving/disproving falsity, knowledge and damages after Escobar
  • Discovery and trial issues in intervened vs. non-intervened cases
  • Role of individual defendants in FCA litigation

Handout 1
Handout 2

 

P5 Kickback and Stark Law Developments

Charles Oppenheim, Partner, Hooper Lundy Bookman
Marlan Wilbanks, Senior Partner, Wilbanks and Gouinlock LLP
Scott Withrow, Partner, Withrow, McQuade & Olsen, LLP

  • Overview of key statutory terms and exceptions for anti-kickback statute
  • Overview of key statutory terms and exceptions for Stark law
  • Overview of enforcement trends and recent noteworthy decisions

Presentation (2 slides/page)
Presentation (3 slides/page)
Handout

 

P6 Enforcement & Compliance Home Health, Hospice and Nursing Homes

Kathleen A. Hessler, Director, Compliance, Simione Healthcare Consultants, LLC
Richard Y. Cheng, Member, Dykema
David Beck, Chief Compliance Officer, Sava Senior Care

  • Identify what’s hot in the enforcement environment for post-acute care providers
  • Learn the life cycle of a corporate integrity agreement (CIA): initiation, negotiation, implementation, management and graduation
  • Discuss requirements for an Independent Review Organization (IRO) and roles of the provider, outside counsel and IRO
  • Examine potential impacts of a CIA on the provider’s financial and clinical operations, its compliance activities, and the post‑graduate effects

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P7 Negotiating False Claims Act Settlements and Mediation

Moderator: Gabriel Imperato, Managing Partner, Nelson Mullins Broad and Cassel
Steve Altman, Principal, Altman Dispute Resolution Services
Patricia L. Hanower, Assistant Director, Civil Division, U.S. DOJ
Michael A. Morse, Partner, Pietragallo Gordon Alfano Bosick & Raspanti, LLP

  • Strategies for responding to False Claims Act cases and negotiating or mediating a resolution with or without the Department of Justice
  • Internal investigations and negotiated or mediated False Claims Act matters
  • Negotiation and/or mediation of parallel False Claims Act (i.e. Medicare, Medicaid and Tri-Care) liability and administrative exclusion and licensure disciplinary matters

Presentation (2 slides/page)
Presentation (3 slides/page)
Handout 1
Handout 2
Handout 3
Handout 4

 

P8 Handling a Criminal Healthcare Fraud Case

Kevin Muhlendorf, Partner, Wiley Rein LLP
Sally Molloy, Assistant Chief, DOJ Criminal Division, Fraud Section, Health Care Fraud Unit

  • Investigative interviewing techniques
  • The use of Big Data
  • Emerging trends in criminal healthcare fraud

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P9 Ask the Stark Professionals

Robert Wade, Partner, Barnes & Thornburg LLP
Lester Perling, Partner, Broad and Cassel
Daniel Melvin, Partner, McDermott Will & Emery, LLP

  • Very brief overview of the Stark Law
  • Respond to pre-submitted & live questions regarding case examples of the application of the Stark Law

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P10 Hot Topics in the False Claims Act

JD Thomas, Waller
Matthew Organ, Partner, Goldberg Kohn Ltd.
Sarah Bogni, Assistant U.S. Attorney, Department of Justice

  • A broad‑based panel offering practical perspectives from government, relators, and defense attorneys on recent developments in the investigation, prosecution, and defense of False Claims Act cases
  • A survey of the real-world effect of recent DOJ guidance, including the Brand Memo regarding the use of agency guidance documents, the Granston Memo regarding the dismissal of non-intervened qui tams, and the Yates Memo
  • Updates on other hot topics in False Claims Act enforcement for healthcare providers, including cases involving medical necessity, Medicare managed care, and Stark

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P11 Federal Administrative Sanctions: Exclusion & Civil Money Penalties

Julie Kass, Shareholder, Baker Ober Health Law
Lauren Marziani, Senior Counsel, HHS OIG

  • Affirmative Exclusions and CMPs: Enforcement Trends and Recent Settlements
  • Intersection with DOJ Investigations, CMS Audits, and Other Parallel Proceedings
  • Compliance Measures that Mitigate Against Liability

Presentation (2 slides/page)
Presentation (3 slides/page)

 

P12 Damages & Liability to Federal Health Programs

Jonathan Diesenhaus, Partner, Hogan Lovells US LLP
Tim Renjilian, Senior Managing Director, FTI Consulting

  • Discuss key concepts in the calculation of damages related to Federal health care programs
  • Address ongoing issues and debates involving damage calculations
  • Analyze newly emerging damage theories from recent settlements and what their implications are

Presentation (2 slides/page)
Presentation (3 slides/page)

 

Monday, November 5 

GS1 DOJ Criminal Update

Joseph Beemsterboer, Chief, Healthcare Fraud Unit, Fraud Section, Criminal Division, U.S. DOJ
Sally Molloy, Assistant Chief, DOJ Criminal Division, Fraud Section, Health Care Fraud Unit
Moderator: Gabriel Imperato, Managing Partner, Nelson Mullins Broad and Cassel

No presentation available

 

GS2 DOJ Civil Update

Michael Granston, Director, Commercial Litigation Branch, Fraud Section, Civil Division, U.S. DOJ
Slides are not available for distribution

 

101 Tackling the Self-Disclosure Puzzle

William Mathias, Shareholder, Baker Ober Health Law
Lisa M. Noller, Partner, Foley & Lardner
Kenneth Kraft, Senior Counsel, HHS OIG

  • Practical advice on when, where, and how to make self-disclosures
  • Discuss pros and cons of making disclosures to DOJ/USAO vs. OIG/CMS vs. contractor
  • Explore alternative approaches to real world hypotheticals

Presentation (2 slides/page)
Presentation (3 slides/page)

 

102 Views from the Trenches: The Government’s Opioid Fraud and Abuse Enforcement Initiatives

Scott Grubman, Partner, Chilivis, Cochran, Larkins & Bever
Neeli Ben-David, Assistant United States Attorney, Northern District of Georgia
Tamala Miles, Assistant Special Agent in Charge, HHS OIG

  • A discussion of the government’s enforcement initiatives related to opioid fraud and abuse
  • Varying viewpoints from both a current Assistant United States Attorney and a defense attorney related to opioid investigations
  • Proactive tips on how healthcare providers can avoid a costly investigation

Presentation  (2 slides/page)
Presentation  (3 slides/page)

 

103 Anatomy of a Corporate Integrity Agreement

Judy Ringholz, Vice President of Compliance and Ethics & Chief Compliance Officer, Jackson Health System
Felicia Heimer, Senior Counsel, HHS OIG

  • Why do health care organizations enter into CIAs?
  • Common and recent features of CIAs
  • Implementing CIA obligations and OIG oversight

Presentation (2 slides/page)
Presentation (3 slides/page)

   

201 Your Health Care Case Just Went Criminal: Why? What Should You Do Now?

David Schumacher, Partner, Hooper, Lundy & Bookman, PC
Miranda Hooker, Partner, Pepper Hamilton LLP

  • Criminal prosecutions of health care providers have exploded in recent years. In this session, a health care fraud prosecutor and a former prosecutor-turned-defense-attorney explain why prosecutors take a health care case to criminal prosecution
  • The speakers will discuss the ramifications of a criminal investigation/indictment and provide tips for compliance professionals and counsel on navigating the investigation and advocating their client’s case to the DOJ
  • The speakers will devote special attention to opioid-related enforcement initiatives, including the new DOJ task forces and recent indictments and trials, which affect virtually every health care provider. Proactive compliance tips will also be discussed

Presentation (2 slides/page)
Presentation (3 slides/page)

 

202 Enforcement Activity in the Research Context

Dwight Claustre, Director, Huron Consulting Group (Retired)
Kristen Schwendinger, Senior Managing Consultant, Berkeley Research Group, LLC

  • Review recent research laws and regulations
  • Overview of recent DOJ and OIG enforcement actions
  • Outline of enforcement activity by other research agencies (OHRP, ORI, NIH, FDA)

Presentation (2 slides/page)
Presentation (3 slides/page)

 

 

203 Wholehearted Journey to Ethics and Compliance: Applying the Resilience Work of Brené Brown to Our Professionals, Teams, and Organizations

Maeve O’Neill, Vice President of Compliance, Addiction Campuses

  • Compliance is a tough job and keeping up with industry standards, laws and regulations requires continuous personal and professional development
  • We can build resilience with increased self-awareness, authenticity and vulnerability
  • Building organizations that engage staff, empower teams and enhance organizational culture will make the Compliance job more enjoyable!

Presentation (2 slides/page)
Presentation (3 slides/page)

   

301 Enforcement and Defense: Point and Counterpoint

Frank E. Sheeder, Partner, Alston & Bird LLP
Gerald T. Roy, VP, Chief Compliance & Privacy Officer, Phoenix Children’s Hospital

  • Healthy discourse between a former HHS-OIG official and a compliance and defense lawyer
  • Contrasting, conflicting, and consistent perspectives
  • Practical advice on how enforcers and providers can work with each other

Presentation (2 slides/page)
Presentation (3 slides/page)

 

302 The Government Enforcement Official and Chief Compliance Officer: Learned Experiences on Pro-Active Initiatives to Mitigate and Minimize Risk

Bret S. Bissey, Vice President, Chief Compliance Officer, Gateway Health
Alec Alexander, Deputy Administrator, CMS, Director, Center for Program Integrity, Centers for Medicare & Medicaid Services

  • Board Governance is a key element of a compliance program. Learn of proactive activities that can be taken to demonstrate that this is working as recommended by OIG-DHHS including making sure the Board is always involved and aware of their obligations.
  • Every investigation/settlement has a history of something that could have been done differently or maybe in a more proactive manner. Hear from the speakers about applicable cases, settlements and investigations where proactive actions were missed.
  • The negotiation activities which surround a CIA or Settlement Agreement can be stressful and potentially result in an agreement which contains flaws or inaccuracies. What elements is the government looking for? Who is best to negotiate for providers?

Presentation (2 slides/page)
Presentation (3 slides/page)

 

303 Effective Compliance with I.M.P.A.C.T

Gurujodha Khalsa, Chief Deputy County Counsel, Kern County
Kristen Lilly, Manager, PYA, P.C.

  • Using Intention, Meditation, Projection, Action, Commitment and Trust
  • Setting Goals, Building the Inner and Outer Skills to Create Effective Compliance
  • Using Human Technology to Enhance Compliance Capability

Presentation (2 slides/page)
Presentation (3 slides/page)

   

401 Managing Your Organization’s Response to a Federal Government Investigation

Precious M. Gittens, Partner, Hooper, Lundy & Bookman PC
Josephine N. Harriott, Deputy Compliance Officer for Health Sciences, Howard University

  • Panelists will review federal directives and guidance related to internal investigations, including the U.S. Sentencing Commission’s Guidelines Manual, the U.S. Attorneys’ Manual and the Yates Memo
  • This presentation will examine ethical and practical issues encountered by in-house and outside counsel during government enforcement actions
  • This panel will discuss best practices for conducting internal investigations, and pitfalls to avoid

Presentation (2 slides/page)
Presentation (3 slides/page)

 

402 Lessons Learned from a Whistleblower

Barbara L. Senters, Chief Compliance & Ethics Officer, Sonic Healthcare USA

  • Hear the story and what we learned when my former company’s leaders met with the whistleblower (after the CIA)
  • Review strategies to use your culture to prevent a whistleblower
  • Discuss how to know if your compliance program is really effective-and how to improve effectiveness

Presentation (2 slides/page)
Presentation (3 slides/page)

 

403 Enforcement of Medicare Enrollment Requirements: Risk Areas, Compliance, and Appeals

Leela Baggett, Associate, Powers, Pyles, Sutter & Verville, P.C.
Andrew B. Wachler, Partner, Wachler & Associates, P.C.
Richard R. Burris, Shareholder, Polsinelli PC

  • Identifying key enrollment risk areas that all current and prospective Medicare providers need to be aware of, along with practical tips and proactive compliance measures to avoid common enrollment pitfalls
  • Dissecting the reasons for revocation and deactivation
  • Navigating through the Medicare enrollment appeals process, including successful appeal strategies for defending against enrollment revocations and denials
  • Collateral consequences to adverse enrollment actions, as well as the interplay between provider enrollment, claims audits, and False Claims Act liability in today’s Medicare landscape

Presentation (2 slides/page)
Presentation (3 slides/page)

 

GS3 Cyber Security and Risk in the Hospital Space

John Riggi, Senior Advisor for Cybersecurity and Risk, American Hospital Association

Presentation (2 slides/page)
Presentation (3 slides/page)

 

Tuesday, November 6

GS4 OIG Update

Gregory Demske, Chief Counsel to the Inspector General, HHS/OIG

Presentation (2 slides/page)
Presentation (3 slides/page)

 

GS5 CMS Update/Program Integrity

Alec Alexander, Deputy Administrator, CMS, Director, Center for Program Integrity, Centers for Medicare & Medicaid Services

Presentation (2 slides/page)
Presentation (3 slides/page)

   

501 State Enforcement Actions: Where Are They Going in Today’s Enforcement Climate?

Candice M. Deisher, Assistant Attorney General, Virginia Attorney General’s Office

Marc S. Raspanti, Partner, Pietragallo, Gordon, Alfano, Bosick & Raspanti, LLP

  • The future of state healthcare fraud investigations
  • What cases are whistleblowers currently filing?
  • Oh no! The state is investigating us! Best practices for fielding a government investigation

Presentation (2 slides/page)
Presentation (3 slides/page)

 

502 General Counsel, Outside Counsel, and Chief Compliance Officer

Nicholas Merkin, CEO, Compliagent
Deborah Gavron-Ravenelle, Chief Compliance Officer, Reliant Medical Group, Inc

  • The rise of mandatory compliance obligations has led to ambiguity concerning the roles and responsibilities of legal and compliance professionals, often leading to tensions and internal misalignment within healthcare organizations
  • Through real life examples from speakers who have served in the role of CCO and counsel to healthcare organizations, this presentation will elucidate the differing roles and goals of the compliance and legal functions
  • The session will conclude with the presentation of a model for effective collaboration among an organization’s CCO, General Counsel, and outside counsel

Presentation (2 slides/page)
Presentation (3 slides/page)

 

503 Conducting an Internal Investigation of a Claims Based Allegation of Non-Compliance

Steven W. Ortquist, Senior Managing Director, Ankura Consulting
Jim Passey, Vice President, Chief Audit & Compliance Officer, HonorHealth

  • Planning the Investigation: An Overview of Key Investigative Tactics
  • Structuring and Conducting an Issue-Appropriate Audit of Claims Issues
  • Managing the Findings of an Investigation

Presentation (2 slides/page)
Presentation (3 slides/page)

   

601 When the Other Brother Steps Up: State Privacy Breach Enforcement Actions

Blaine A. Kerr, Chief Privacy Officer, Jackson Health System

Gregory V. Kerr, Managing Director, Ankura Consulting Group, LLC

Juan Carlos Palacio, Associate Director, Jackson Health System

  • A discussion of state privacy enforcement actions and the trends at the state and multistate level
  • Strategic insights to navigate potential state enforcement liability when faced with privacy breaches
  • Methods to review and revise privacy strategies to more effectively address state breach notification requirements

Presentation (2 slides/page)
Presentation (3 slides/page)

 

602 What to Do When the Government Comes Knocking: An Insider Perspective on Government Subpoenas

Jason Mehta, Partner, Bradley
Kyle Cohen, Assistant US Attorney

  • A current AUSA (Kyle Cohen, MDFL) and former AUSA (Jason Mehta) discuss government investigations, including issuance of Civil Investigative Demands, administrative subpoenas, and other enforcement tools
  • Practical advice on how best to respond to the government, how to facilitate early and on-going cooperation, how to defend your interests while also being responsive to the government, and how to negotiate successful resolutions
  • Presentation will include a primer on government investigation origins, enforcement tools available to government investigators, possible outcomes of investigations, as well as opportunities for participants to ask questions

Presentation (2 slides/page)
Presentation (3 slides/page)

 

603 340B Program Compliance: Pitfalls, Disclosures, and Best Practices

Cindy K. Bartlett, VP Corporate Responsibility, Bon Secours
Barbara Williams, Principal, Powers

  • Overview of 340B program requirements
  • What to do if a compliance issue is discovered
  • Compliance pitfalls and best practices

Presentation (2 slides/page)
Presentation (3 slides/page)

   

701 Navigating the Changing Regulatory and Enforcement Landscape Relating to Opioids

Anna M. Grizzle, Partner, Bass, Berry & Sims PLC
Jerry Williamson, Healthcare Consultant

  • Overview of current regulatory and enforcement landscape related to the opioid epidemic and potential risks for physicians and other healthcare providers and facilities, including review of recent enforcement actions and initiatives
  • Physician’s perspective on balancing the current enforcement environment with quality patient care and tips for providers to stay up to date on regulatory changes
  • Practical advice from medical and legal perspectives on navigating the changing enforcement minefield and developing compliance processes to protect against potential issues

Presentation (2 slides/page)
Presentation (3 slides/page)

 

702 Organization & Individual Liability: Strategies for Managing Risk

Thomas Moran, Attorney, Nelson Mullins
Gabriel Imperato, Managing Partner, Nelson Mullins Broad and Cassel

  • Analyzing DOJ policy on individual liability for decision makers
  • Trends in individual enforcement of fraud and abuse laws
  • Possible protections and best practices for individuals

Presentation (2 slides/page)
Presentation (3 slides/page)

 

703 Three Competing Perspectives on Federal Health Care Enforcement Trends: Federal Prosecutor, In-House Counsel, Outside Counsel

Scott McBride, Partner, Lowenstein Sandler, LLP
Joseph Mack, Senior Compliance Counsel, Bayer U.S
Bernard Cooney, Assistant United States Attorney, Office of the United States Attorney, District of New Jersey

  • The panel will discuss current enforcement trends in the federal health care arena. Topics will include FCPA enforcement, as well as developments in False Claims Act litigation (including the Granston and Brand Memoranda)
  • Subjects will also include recent developments in First Amendment law in the off-label marketing space, as well as anti-kickback statute and related safe harbor developments
    The panel will additionally explore other potential new hot enforcement areas

Presentation (2 slides/page)
Presentation (3 slides/page)

 

801 Recent Developments in Individual Criminal and Civil Culpability

Gejaa Gobena, Partner, Hogan Lovells LLP
Laura Cordova, Partner, Crowell& Moring LLP
Edward Crooke, Assistant Director, Civil Division, U.S. DOJ
Kathleen McGovern, Principal, Ernst & Young

  • In September 2015, then-Deputy Attorney General Sally Yates issued a memorandum directing the Department of Justice to focus on individual culpability when evaluating white collar criminal and civil cases
  • This panel of current and former government prosecutors will discuss the Department’s enforcement activity with respect to individuals over the past several years, with a particular focus on interesting developments in civil enforcement matters
  • The panel will discuss specific pleas or resolutions in civil and criminal white collar cases in the past few years and the factors the government takes into account when addressing individual accountability

Presentation (2 slides/page)
Presentation (3 slides/page)

 

802 Compliance Education and Enforcement: Engaging Leadership Amid Government Scrutiny

Robert Rabecs, Partner, Husch Blackwell LLP
Katherine Matos, Senior Counsel, U.S. Dept. of Health & Human Services, Office of Inspector General

  • Elements of an effective compliance program
  • Oversight responsibilities for healthcare governing boards
  • Recent enforcement actions and court decisions involving board member and manager liability

Presentation (2 slides/page)
Presentation (3 slides/page)

 

803 Being an Excellent Compliance Officer: Tried and True Techniques in this Tough Enforcement Environment

Frank E. Sheeder, Partner, Alston & Bird LLP
James Hearty, Chief Compliance Officer, DaVita Kidney Care

  • Defining the Compliance Officer’s role
  • Leveraging organizational resources
  • Converting the naysayers to compliance champions

Presentation (2 slides/page)
Presentation (3 slides/page)

 

GS6 Enforcement and the Opioid Crisis Discussion

Moderator: Jason Mehta, Partner, Bradley
Gary Cantrell, Deputy Inspector General for Investigations, OIG HHS
Edward Crooke, Assistant Director, Civil Division, U.S. DOJ
Mary Daly, Associate Deputy Attorney General and Director of Opioid Enforcement and Prevention, U.S. DOJ

No presentation available

 

Wednesday, November 7 

W1 Trying a False Claims Act (FCA) Qui Tam Case

Mike Bittman, Partner, Broad & Cassel
Greg Luce, Partner, Skadden, Arps, Slate, Meagher & Flom LLP

  • Understand the FCA qui tam Law as a foundation for learning litigation tactics and defense strategy;
  • Explore strategy and tactics to proactively prevent, investigate and defend FCA complaints and DOJ/Relator enforcement actions; and
  • Learn tips, best practices and lessons from recent FCA enforcement actions.

Presentation (2 slides/page)
Presentation (3 slides/page)

 

W2 Cybersecurity and Privacy Risks that Create Enforcement and Other Exposure

Marti Arvin, Vice President, Audit Strategy, CynergisTek, Inc.
Joan Podleski, Chief Privacy Officer, Children’s Health System of Texas
Timothy Noonan, Acting Deputy Dir, Health Information Privacy Division, U.S. Dept of Health and Human Services Office for Civil Rights

  • Discussion of the evolution of cybersecurity and privacy risks in healthcare and its unique challenges
  • Discussion of the maturity of cybersecurity and privacy compliance in healthcare organizations
  • OCR Phase II audit results and why they demonstrate the continued lack of focus on cybersecurity and privacy by healthcare

Presentation (2 slides/page)
Presentation (3 slides/page)

 

W3 What Makes a Compliance Program Effective?

Judy A. Ringholz, Vice President of Compliance and Ethics & Chief Compliance Officer, Jackson Health System
Thomas Beimers, Partner, Hogan Lovells
Felicia Heimer, Senior Counsel, HHS OIG

  • Review recent DOJ and OIG guidance and discuss the role of board and compliance committee members
  • Discuss areas of focus for a compliance program and how to prioritize compliance initiatives and work plan items
  • Suggest measures by which the effectiveness of a compliance program can be determined

Presentation (2 slides/page)
Presentation (3 slides/page)

 

W4 Opioid Crisis: Overprescribing Doctors and Senior Living

Judith Coffey, Director of Compliance and Counsel, Managed Health Services
Timothy McClure, Manager of Special Investigation Unit, Managed Health Services
Brittany Pape, Director of Compliance, Senior Lifestyle Corporation

  • Protection measures against opioid abuse in senior living
  • Overprescribing doctors—what to do? Education, prepayment review, audit, suspension, termination, referrals, reporting and more
  • Member consequences after actions against overprescribing doctors

Presentation (2 slides/page)
Presentation (3 slides/page)

 

W5 Compensation, Arrangements, Stark, Anti‑Kickback Statute, and Fair Market

David M. Glaser, Shareholder, Fredrikson & Byron PA
Joan W. Feldman, Partner, Shipman & Goodwin LLP

  • What are fair market valuations? How are they determined? Why FMV determinations are important: underlying legal concepts and consequences of getting it wrong (Stark, anti-kickback, and tax-exempt law)
  • Understand why many salary surveys are deeply flawed and other reasons you may not have the Stark problem you think you do
  • Best practices: providers’ current approaches, recent developments and common mistakes/misconceptions with FMV models and the risks they present

Presentation (2 slides/page)
Presentation (3 slides/page)

 

W6 False Claims Act Developments

Moderator: Jonathan Diesenhaus, Partner, Hogan Lovells US LLP
Tejinder Singh, Partner, Goldstein & Russell, P.C.
David Wiseman, Civil Fraud Branch, Civil Fraud Section, US DOJ
Laurence J. Freedman, Member, Mintz

  • Post Escobar and liability under the False Claims Act
  • The relationship between “materiality” under Escobar and a Department of Justice intervention decision
  • Proving or disproving “medical necessity” in False Claims Act cases
  • False Claims Act damages

Presentation (2 slides/page)
Presentation (3 slides/page)