Stemming back to 1863, the False Claims Act, which is often referred the “Lincoln Law”, remains the federal government’s number one fraud fighting tool for returning monies to the federal fisc. The 1986 Amendments, as well as the various amendments under the Fraud Enforcement and Reduction Act (FERA) and the Affordable Care Act (ACA), have given the government and relators’ counsel additional tools and avenues to pursue in relation to False Claims Act cases.
Combatting healthcare fraud has been and remains a top priority for the U.S. Department of Justice – Civil Frauds Division, as well as the Department of Health and Human Services’ (HHS) Health Care Fraud Prevention and Enforcement Task Force (HEAT) and HHS Office of the Inspector General. Common areas of enforcement include Anti-Kickback Statute (AKS), Stark Law, factually false claims where no goods or services were provided but claims were submitted to government programs for payment. Additionally, new areas of interest include cybersecurity, COVID-19 fraud, and Controlled Substance Act violations. In 2023, two opinions were issued by the United States Supreme Court addressing two areas of the False Claims Act.
Fortunately, compliance departments and defense counsel have a roadmap for mitigating liability in certain circumstances – both for corporate entities and for individuals. The purpose of this webinar is to provide an overview of what constitutes a false and fraudulent claim, what scienter is required, and recent cases from the hot areas in healthcare, as well risk mitigation strategies.
What You’ll Learn From This Course
- Understand the nuances of the False Claims Act
- Appreciate the key areas of enforcement
- Learn about the key take-aways from recent Supreme Court cases
- Mitigate risk through the OIG’s Guidance
- Recognize potential false and fraudulent claims before submission
- Be cognizant of the knowledge requirement in the False Claims Act
Areas Covered in the Session
- False Claims Act
- Fraud, waste and abuse
- Stark Law
- Knowledge requirements for false and fraudulent claims
- Recent cases
- OIG and DOJ Compliance items
- Risk mitigation
- Live Q&A session
- Hospital Executives – CEOs, COOs, CFOs, CNOs, and CMOs
- Other Healthcare Provider Executives
- Healthcare provider Board Members
- Attorneys representing health care providers and practitioners
- Chief compliance officers
- Government Organizations
- Defense Counsel
- Relator’s Counsel
- Compliance Officers
- Billers and Coders
- Cybersecurity Professionals & Consultants
- Anyone in Healthcare
About the Presenters
Rachel V. Rose, JD, MBA successfully advises and represents clients on healthcare, cybersecurity, securities, and qui tam compliance, transactional, litigation, and government enforcement matters. Ms. Rose is also an Affiliated Member with the Baylor College of Medicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics. She has served as a consultative expert and testifying expert, as well as being often quoted in publications.
In addition to being extensively published and a sought-after presenter and quoted expert, Ms. Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University, and a law degree from Stetson University College of Law, where she graduated with various honors, including the National Scribes Award. Ms. Rose also attained a Certificate in Negotiation and Leadership from Harvard University.
Ms. Rose is licensed in Texas and is a Fellow of the Federal Bar Association. Currently, she serves as a Director on the FBA’s National Board, is a Member of and the Immediate Past Chair of the Federal Bar Association’s Government Relations Committee, an Advisory Board member of the Federal Bar Association’s Qui Tam Section, the co-editor of the American Health Lawyers Association’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), as well as a co-author of the ABA’s books The ABCs of ACOs and What Are International HIPAA Considerations? She is extensively published and presents on a variety of matters related to her practice.
She has been named consecutively to the Texas Bar College, the National Women Trial Lawyers Association’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National Trial Lawyers Association’s Top 100 and The Nation’s Top One Percent. Ms. Rose was awarded 1st Healthcare Compliance’s 2019 and 2022 Top Presenter Award. In 2023, she was selected for SuperLawyers (healthcare).