Recent cases and/or enforcement actions involving the Federal Civil False Claims Act (FCA) raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates. Add to that, a substantial number of enforcement actions involve the Medicare/Medicaid Fraud and Abuse Anti‑Kickback Statute (AKS), violation of which has been held to be the basis of an action under the FCA.
The AKS is alive, still with us and as viable as ever. The Statute provides that the offer or payment, as well as the solicitation or receipt, of “any remuneration” in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited.
This session will describe how to protect yourself and your organization, and 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 last year 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, whistle-blowers have been awarded nearly $4 billion, with $439 million in awards in fiscal year 2012. And whistle-blowers 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, and the Hardeman Memorial Hospital case in Texas, with a settlement of $398, 230.56 stand out. In 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.
Areas Covered In The Session:
- Federal False Claims Act
- 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
- Recent cases and best practices in the industy
- Provide an overview of the Federal Civil False Claims Act (FCA) and show how it works.
- Provide an overview of the Federal Anti-Kickback Statute and show how violations can be mitigated.
- Provide an assessment of enforcement activities with an emphasis on prevention and compliance.
- Show how participants may be at risk.
- Preview recent cases and show how they potentially impact participants.
- Hospital CEOs
- Chief Oration Officers
- Chief Financial Officers
- Chief Medical Officers
- Compliance Officers
- Nursing home executives
- Physician practice managers
- Other healthcare provider executives
About The Speaker:
William Mack Copeland, MS, JD, PhD, LFACHE, practices health care law in Cincinnati at the firm of Copeland Law, LLC, where he is president and CEO. 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. A former hospital chief executive officer, he was awarded the American College of Health Care Executives Senior-Level Healthcare Executive Regent’s Award in 2007.