HomeWebcastUnderstanding the New System: Final Rule on Fraud Prevention in Medicaid, Medicare and CHIP
Final Rule on Fraud Prevention CLE

Understanding the New System: Final Rule on Fraud Prevention in Medicaid, Medicare and CHIP

Live Webcast Date: Monday, October 03, 2011 from 3:00 pm to 5:00 pm (ET)
Legal (CLE)Recording

Final Rule on Fraud Prevention

Join us for this Knowledge Group Final Rule on Fraud Prevention Webinar. The Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 25, 2011, which enacts a number of program integrity provisions of the Patient Protection and Affordable Care Act (PPACA). These provisions aim to reduce fraud, waste and abuse in Medicare, Medicaid, and Children’s Health Insurance Program (CHIP).

The guidance focuses primarily on the new & technically complicated enrollment processes for Healthcare providers and suppliers and CMS’s expanded authority to impose payment suspensions.

Healthcare providers and suppliers will need to work closely with their compliance and corporate counsel/officers to ensure that an effective process is in place.

The Knowledge Group is assembling a panel of key thought leaders and experts to give insights of the most important issues. This 2-hour webcast will discuss the following key provisions:

  • New Medicare provider and supplier screening procedures
  • Screening methods performed under the Medicare program
  • Who are affected?
  • Application fees on Medicare, Medicaid and CHIP
  • CMS amendment to 42 C.F.R. §§ 405.370 through 405.372
  • Withholding payments
  • Future of payment suspensions and compliance plans
  • Other Provisions

Agenda

SEGMENT 1:
George B. Breen, Member of the Firm, Co-Chair, Health Care and Life Sciences Litigation and Government Investigations Practice Group, 
Epstein Becker & Green, P.C.

  • Suspension of Payments
    • The Final Rule implements section 6402(h) of the ACA which establishes requirements for the suspension of Medicare and Medicaid payments pending investigation of credible allegations of fraud.
      • What are the standards for Medicare and Medicaid payment suspension under the ACA and in what ways do they differ?
      • What is a “credible allegation of fraud”?
      • How long can a payment suspension last?
      • Under what circumstances might CMS forego suspension, or elect to terminate a payment suspension?

SEGMENT 2:

Carolyn Fitzhugh McNiven, Partner (Former Federal Prosecutor), 
DLA Piper

  • Temporary Moratoria on Enrollment of Providers and Suppliers
    • The ACA gave the Secretary of HHS new authority to impose temporary moratoria on the enrollment of new Medicare, Medicaid, or CHIP providers and suppliers,
      • Under what circumstances can the Secretary impose this moratoria?
      • Is there any time limit to the moratoria?
      • Are there any standards which need to be met in order to impose an enrollment moratorium?

SEGMENT 3:
Craig Smith, Partner/Board Certified – Health Law, 
Hogan Lovells US LLP

  • Enhanced Provider and Supplier Screening under Medicare, Medicaid, and CHIP
    • The ACA requires the Secretary of HHS, in consultation with the OIG, to establish screening procedures for providers and suppliers under Medicare, Medicaid and CHIP.
      • What are the new screening procedures and what are the screening levels?
      • Which providers and suppliers do these procedures apply to?
      • How will these procedures be applied to current providers and suppliers? How are they applied to new enrollees?
      • How are corporate compliance programs impacted by these new requirements?

Who Should Attend

  • Healthcare Providers
  • Healthcare Suppliers
  • Health Services Professionals
  • Health Care Advisory Services Consultants
  • Health Plan Professionals
  • State Health Executives/Professionals
  • Healthcare Finance People
  • Health Industry Advisors
  • Health Care Law Attorneys
  • Attorneys, General Counsel at Hospitals
  • Health Policy Directors
  • Consulting Organization Professionals
  • Medicare Beneficiaries
  • Agents
  • Managing employees
  • Consultants & Accountants
  • Other Related/Interested Professionals

Final Rule on Fraud Prevention

SEGMENT 1:
George B. Breen, Member of the Firm, Co-Chair, Health Care and Life Sciences Litigation and Government Investigations Practice Group, 
Epstein Becker & Green, P.C.

  • Suspension of Payments
    • The Final Rule implements section 6402(h) of the ACA which establishes requirements for the suspension of Medicare and Medicaid payments pending investigation of credible allegations of fraud.
      • What are the standards for Medicare and Medicaid payment suspension under the ACA and in what ways do they differ?
      • What is a “credible allegation of fraud”?
      • How long can a payment suspension last?
      • Under what circumstances might CMS forego suspension, or elect to terminate a payment suspension?

SEGMENT 2:

Carolyn Fitzhugh McNiven, Partner (Former Federal Prosecutor), 
DLA Piper

  • Temporary Moratoria on Enrollment of Providers and Suppliers
    • The ACA gave the Secretary of HHS new authority to impose temporary moratoria on the enrollment of new Medicare, Medicaid, or CHIP providers and suppliers,
      • Under what circumstances can the Secretary impose this moratoria?
      • Is there any time limit to the moratoria?
      • Are there any standards which need to be met in order to impose an enrollment moratorium?

SEGMENT 3:
Craig Smith, Partner/Board Certified – Health Law, 
Hogan Lovells US LLP

  • Enhanced Provider and Supplier Screening under Medicare, Medicaid, and CHIP
    • The ACA requires the Secretary of HHS, in consultation with the OIG, to establish screening procedures for providers and suppliers under Medicare, Medicaid and CHIP.
      • What are the new screening procedures and what are the screening levels?
      • Which providers and suppliers do these procedures apply to?
      • How will these procedures be applied to current providers and suppliers? How are they applied to new enrollees?
      • How are corporate compliance programs impacted by these new requirements?

Final Rule on Fraud Prevention

Final Rule on Fraud Prevention

Carolyn Fitzhugh McNivenPartner (Former Federal Prosecutor)DLA Piper

Carolyn McNiven, a former federal prosecutor, handles white collar criminal defense and related administrative, regulatory and compliance matters for individuals and companies and has particular expertise in the areas of health care, food and drug, and FCPA compliance counseling, risk assessment and litigation.

After graduating from U.C. Berkeley’s Boalt Hall Law School, where she served as editor on the law review, Ms. McNiven clerked for a federal district court judge and practiced law at a prominent Chicago firm and the US Department of Justice before joining DLA Piper in 2010 as a partner.

Although Ms. McNiven is an active trial attorney, having personally tried numerous cases in both federal and state courts, she has also been successful in less public arenas where she has obtained favorable results for clients in negotiations with government attorneys in the context of criminal, civil and regulatory actions. Ms. McNiven understands from first-hand experience what government decision-makers, judges and juries find persuasive, and uses those skills to counsel and defend clients facing high-stakes investigations and litigation.

She has experience handling fraud, antitrust, Foreign Corrupt Practices Act (FCPA), public corruption, tax, Dodd-Frank whistleblower investigations and securities matters and providing compliance counseling to public and private entities. For health care sector clients, she provides anti-kickback and Stark Act advice, risk assessments, False Claims Act (FCA) defense and loss computations, fraud and FCA due diligence, qui tam defense, and defense of misbranding and other food and drug offenses. She also has extensive experience in provider-side health care fraud enforcement and serves as DLA Piper’s point person on food safety issues.

Final Rule on Fraud Prevention

Craig SmithPartner/Board Certified - Health LawHogan Lovells US LLP

Craig Smith rejoined the firm in 2008 after serving as General Counsel for Florida’s Agency for Health Care Administration. Craig is Board Certified in Health Law by the Florida Bar, and he represents health care industry clients on a wide range of regulatory, transactional, and litigation matters.

As General Counsel of the agency with a budget of over $17 billion that regulates more than 32,000 health care facilities, Craig supervised over 40 in-house lawyers in four different offices across Florida and was a member of the agency’s Senior Management Team. Craig oversaw significant class action and other complex litigation against the agency at the trial court and appellate court levels, and he addressed many critical health care issues, including statewide Medicaid managed care reform and the appropriate expansion of electronic health information.

While serving as the chief legal officer of one of the nation’s largest Medicaid programs, Craig coordinated frequently with federal officials at the Centers for Medicare and Medicaid Services and the Department of Justice. He was a member of the South Florida Health Care Fraud Task Force, and he represented the agency in its recovery of Medicaid overpayments, including one of the largest Medicaid overpayment recoveries in history. Craig also worked closely with Governor Crist’s administration on legislative initiatives and to create innovative health care programs such as Cover Florida and Florida’s Prescription Drug Discount Card Program.

Final Rule on Fraud Prevention

George B. BreenMember of the Firm, Co-Chair, Health Care and Life Sciences Litigation and Government Investigations Practice GroupEpstein Becker & Green, P.C.

GEORGE B. BREEN is a Shareholder of Epstein Becker & Green, P.C and a member of its Health Care and Life Sciences and Litigation practices. A litigator for over twenty years, Mr. Breen focuses his practice on the representation of health care and life sciences clients, both corporations and individuals, in government investigations and complex litigation.

Mr. Breen:

  • Defends clients undergoing investigation for health care fraud by the Department of Justice, the Department of Health and Human Services Office of the Inspector General, and other state and federal governmental authorities
  • Serves as defense counsel in connection with False Claims Act cases (including qui tam litigation)
  • Conducts internal investigations and advises clients on compliance issues
  • Represents MCOs, HMOs, nursing homes, home health agencies, health care providers, manufacturers and suppliers before courts and administrative tribunals at the federal and state level, including challenges to regulatory actions and disputes under government contracts
  • Defends individuals and organizations against claims of malpractice and professional liability

He is a Vice Chair of the American Health Lawyers Association’s Healthcare Liability and Litigation Practice Group and a Past President and Board member of the District of Columbia Defense Lawyers Association. Mr. Breen is also a frequent lecturer and author on fraud and abuse issues and health care litigation

Mr. Breen has been Peer Review rated “AV” by the Martindale-Hubbell Law Directory and was named an “Outstanding Healthcare Litigator” by Nightingale’s Healthcare News in January 2010, one of only 10 lawyers across the country selected for this honor.


Click Here to Read Additional Material

Final Rule on Fraud Prevention

Course Level:
   Intermediate

Advance Preparation:
   Print and review course materials

Method Of Presentation:
   On-demand Webcast

Prerequisite:
   NONE

Course Code:
   114146

Total Credits:
    2.0 CLE

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About the Knowledge Group

The Knowledge Group

The Knowledge Group has been a leading global provider of Continuing Education (CLE, CPE) for over 13 Years. We produce over 450 LIVE webcasts annually and have a catalog of over 4,000 on-demand courses.

About the Knowledge Group

The Knowledge Group

The Knowledge Group has been a leading global provider of Continuing Education (CLE, CPE) for over 13 Years. We produce over 450 LIVE webcasts annually and have a catalog of over 4,000 on-demand courses.

In the US, DLA Piper represents many of the world’s leading companies across industries, as well as emerging businesses, financial institutions and professional firms. We offer legal counsel on a wide range of issues in every major business, financial and technology center in the US, where our lawyers have both local and national experience. Globally, we have 4,200 lawyers in 30 countries, enabling us to offer our clients comprehensive cross-border counsel wherever they need us.

Hogan Lovells is a top 10 global legal services provider offering a depth of experience and a broad practice scope through its 2,500+ lawyers in more than 40 offices in 20 countries around the world.

Epstein Becker & Green, P.C., founded in 1973, is a national law firm with approximately 300 lawyers practicing in 10 offices, in Atlanta, Boston, Chicago, Houston, Los Angeles, New York, Newark, San Francisco, Stamford, and Washington, D.C. The Firm is uncompromising in its pursuit of legal excellence and client service in its areas of practice: Health Care and Life Sciences,Labor and Employment, LitigationCorporate Services, and Employee Benefits. Epstein Becker & Green was founded to serve the health care industry and has been at the forefront of health care legal developments since 1973. The Firm is also proud to be a trusted advisor to clients in the financial services and hospitality industries, among others, representing entities from Fortune 100 companies to startups. Our commitment to these practices and industries reflects the founders’ belief in focused proficiency paired with seasoned experience.

For more information about George B. Breen and Epstein Becker & Green, P.C., please visit: www.ebglaw.com.

Carolyn McNiven, a former federal prosecutor, handles white collar criminal defense and related administrative, regulatory and compliance matters for individuals and companies and has particular expertise in the areas of health care, food and drug, and FCPA compliance counseling, risk assessment and litigation.

After graduating from U.C. Berkeley’s Boalt Hall Law School, where she served as editor on the law review, Ms. McNiven clerked for a federal district court judge and practiced law at a prominent Chicago firm and the US Department of Justice before joining DLA Piper in 2010 as a partner.

Although Ms. McNiven is an active trial attorney, having personally tried numerous cases in both federal and state courts, she has also been successful in less public arenas where she has obtained favorable results for clients in negotiations with government attorneys in the context of criminal, civil and regulatory actions. Ms. McNiven understands from first-hand experience what government decision-makers, judges and juries find persuasive, and uses those skills to counsel and defend clients facing high-stakes investigations and litigation.

She has experience handling fraud, antitrust, Foreign Corrupt Practices Act (FCPA), public corruption, tax, Dodd-Frank whistleblower investigations and securities matters and providing compliance counseling to public and private entities. For health care sector clients, she provides anti-kickback and Stark Act advice, risk assessments, False Claims Act (FCA) defense and loss computations, fraud and FCA due diligence, qui tam defense, and defense of misbranding and other food and drug offenses. She also has extensive experience in provider-side health care fraud enforcement and serves as DLA Piper’s point person on food safety issues.

Craig Smith rejoined the firm in 2008 after serving as General Counsel for Florida’s Agency for Health Care Administration. Craig is Board Certified in Health Law by the Florida Bar, and he represents health care industry clients on a wide range of regulatory, transactional, and litigation matters.

As General Counsel of the agency with a budget of over $17 billion that regulates more than 32,000 health care facilities, Craig supervised over 40 in-house lawyers in four different offices across Florida and was a member of the agency’s Senior Management Team. Craig oversaw significant class action and other complex litigation against the agency at the trial court and appellate court levels, and he addressed many critical health care issues, including statewide Medicaid managed care reform and the appropriate expansion of electronic health information.

While serving as the chief legal officer of one of the nation’s largest Medicaid programs, Craig coordinated frequently with federal officials at the Centers for Medicare and Medicaid Services and the Department of Justice. He was a member of the South Florida Health Care Fraud Task Force, and he represented the agency in its recovery of Medicaid overpayments, including one of the largest Medicaid overpayment recoveries in history. Craig also worked closely with Governor Crist’s administration on legislative initiatives and to create innovative health care programs such as Cover Florida and Florida’s Prescription Drug Discount Card Program.

GEORGE B. BREEN is a Shareholder of Epstein Becker & Green, P.C and a member of its Health Care and Life Sciences and Litigation practices. A litigator for over twenty years, Mr. Breen focuses his practice on the representation of health care and life sciences clients, both corporations and individuals, in government investigations and complex litigation.

Mr. Breen:

  • Defends clients undergoing investigation for health care fraud by the Department of Justice, the Department of Health and Human Services Office of the Inspector General, and other state and federal governmental authorities
  • Serves as defense counsel in connection with False Claims Act cases (including qui tam litigation)
  • Conducts internal investigations and advises clients on compliance issues
  • Represents MCOs, HMOs, nursing homes, home health agencies, health care providers, manufacturers and suppliers before courts and administrative tribunals at the federal and state level, including challenges to regulatory actions and disputes under government contracts
  • Defends individuals and organizations against claims of malpractice and professional liability

He is a Vice Chair of the American Health Lawyers Association’s Healthcare Liability and Litigation Practice Group and a Past President and Board member of the District of Columbia Defense Lawyers Association. Mr. Breen is also a frequent lecturer and author on fraud and abuse issues and health care litigation

Mr. Breen has been Peer Review rated “AV” by the Martindale-Hubbell Law Directory and was named an “Outstanding Healthcare Litigator” by Nightingale’s Healthcare News in January 2010, one of only 10 lawyers across the country selected for this honor.

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