Healthcare Fraud: Identifying and Assessing Fraud Risks, Implications of Current Enforcement, Ensuring Compliance

In 2014, the federal government recovered almost $6 billion in healthcare fraud cases, up almost $2 billion from the prior year. Providers participating in federal healthcare programs (Medicare, Medicaid, TRICARE) are required to assess fraud risks and take steps to minimize those risks--or face stiff penalties.

Healthcare fraud doesn’t just mean the provider who bills for services never rendered. Schemes come in many forms: falsifying a patent’s diagnosis to justify the procedures or tests that were done; providing medically unnecessary services done to generate insurance payments; or accepting compensation (kickbacks) for patient referrals.

Counsel to healthcare providers must evaluate the risks for healthcare fraud to prevent and minimize the likelihood of fraudulent conduct. Further, as both federal and state authorities pursue and prosecute healthcare fraud, healthcare counsel must stay on top of the latest enforcement trends to ensure compliance programs are in place and properly implemented.

Listen as our authoritative panel of healthcare attorneys examines assessment of healthcare fraud risks and the current enforcement trends. The panel will also provide best practices for minimizing healthcare fraud.

1. Assessing healthcare fraud risks
   1. Stark
   2. AKS
   3. Business arrangements/strategies that raise fraud and abuse risks
   4. False claim risks—payors, plans, MCOs
2. Enforcement trends
3. Best practices to avoid or minimize healthcare fraud

The panel will review these and other key issues:

• Where do fraud risks arise for healthcare providers?
• What are the enforcement trends that healthcare counsel must understand?
• What steps can healthcare providers take now to mitigate their exposure to fraud claims?