Understanding the New System: Final Rule on Fraud Prevention in Medicaid, Medicare and CHIP
Overview:
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?
- 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.
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?
- 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,
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?
- 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.
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
Carolyn McNiven, a former federal prosecutor, handles white collar criminal defense and related administrative, regulatory and compliance matters for individuals …
Craig Smith rejoined the firm in 2008 after serving as General Counsel for Florida’s Agency for Health Care Administration. Craig …
GEORGE B. BREEN is a Shareholder of Epstein Becker & Green, P.C and a member of its Health Care and …
Course Level:
Intermediate
Advance Preparation:
Print and review course materials
Method of Presentation:
On-demand Webcast (CLE)
Prerequisite:
NONE
Course Code:
114146
Total Credits:
2.0 CLE
Login Instructions:
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SPEAKERS' FIRMS:
About DLA Piper
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.
About Hogan Lovells US LLP
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.
About Epstein Becker & Green, P.C.
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, Litigation, Corporate 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.