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Course Details

Course Information
  • smart_display Format

    On-Demand

  • signal_cellular_alt Difficulty Level

  • work Practice Area

    Health

Date & Time
  • event Date

    Thursday, October 6, 2022

  • schedule Time

    1:00 p.m. ET./10:00 a.m. PT

  • timer Program Length

    90 minutes

Credit Information

  • This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$297.00
CLE
ALL

This CLE course will guide counsel to healthcare insurers and providers on bringing and defending overpayment recovery claims. The panel will provide practical insight from both plan and provider perspectives on implementing and dealing with health insurer audits, overpayment demands, and recoveries.

Faculty

Steven D. Hamilton
Partner
Reed Smith

Mr. Hamilton is an seasoned trial lawyer who focuses his practice on healthcare litigation and regulatory issues. As an experienced trial attorney, he has managed and directly handled all aspects of cases, including first and second chairing multiple trials and arbitration hearings, as well as appellate briefs and arguments.

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David S. Greenberg
Partner
ArentFox Schiff LLP

Mr. Greenberg advises health care companies, including providers and suppliers, through an exceedingly complex and volatile regulatory environment. He focuses his practice on counseling health care clients on regulatory issues related to the Affordable Care Act, the False Claims Act, the Anti-Kickback Act, the Stark Laws, state licensure, self-disclosures, reimbursement and payment, and participation in Medicare, Medicaid, and other government health care programs. 

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Description

The government has focused on fighting healthcare fraud and abuse and pursuing overpayments. They are not alone in this endeavor. Health plans are also tasked with combating fraud and abuse (by contract or by their own initiative). The result is that health insurers have become increasingly more active in investigating potential provider fraud and abuse and seeking the recovery of overpayments from healthcare providers.

Both health insurers and providers must understand the regulatory framework under which claims for overpayments are brought. Further, counsel to providers should evaluate the merits of the claims and be prepared to challenge them.

Listen as our authoritative panel of healthcare attorneys provides practical insight from both plan and provider perspectives on implementing and dealing with overpayment demands and recoveries.

Outline

  1. Regulatory framework
  2. Key considerations
    1. Basis for recovery
    2. Merits of claim
    3. Scope of recovery
  3. Best practices
    1. For healthcare providers
    2. For health insurers

Benefits

The panel will review the following important issues:

  • Hot trends in fraud and abuse (what are health insurers looking at), recent recovery actions and settlements, including lessons learned
  • Key considerations when determining to bring recovery claims and defending against such claims
  • Best practices for challenging health insurer audits, sampling, and extrapolation evidence