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.
Presented By
Ms. Gallagher is an experienced nurse-attorney with a diverse background in healthcare, litigation, investigations, and executive leadership. Since 2018, she led Fraud, Waste, and Abuse (FWA) efforts, then litigation management at Commonwealth Care Alliance, continuing in this role following its 2025 acquisition by CareSource. She previously held senior legal roles at the Insurance Fraud Bureau of Massachusetts and the Investigations Division of the Massachusetts Department of Mental Health. Ms. Gallagher is a Certified Fraud Examiner (CFE) and Certified Professional in Patient Safety (CPPS) and has also served as adjunct faculty at MCPHS University.
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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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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Date + Time
- event
Wednesday, October 1, 2025
- schedule
1:00 p.m. ET./10:00 a.m. PT
I. Regulatory framework
II. Key considerations
A. Basis for recovery
B. Merits of claim
C. Scope of recovery
III. Best practices
A. For healthcare providers
B. For health insurers
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 whether to bring recovery claims and defending against such claims
- Best practices for challenging health insurer audits, sampling, and extrapolation evidence
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