The Federal False Claims Act: Enforcement and Recent Updates

The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works.  It will also provide an assessment of enforcement activities, showing how healthcare providers may be at risk. In addition, the session will review recent cases and show how they potentially impact healthcare providers.

We will start with a review of the Federal False Claims Act and discuss how it works and how it is being used to fight health care fraud.  We will discuss how the various health care fraud task forces use the Federal False Claims Act and its whistleblower provisions to identify and prosecute health care fraud.  The webinar will take the Federal False Claims Act apart and show step by step how an action is filed, how the government responds, and how the courts interpret various elements of the Act. We will discuss proof, damages under the Act, and how the whistleblower is rewarded for bringing a successful case.

The session will also provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as a general review of the AKS available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.

We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are.  We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law.

We will also review the changes made to both the False Claims Act and the Anti-Kickback Statute made by the Affordable Care Act.

Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it.  In addition, we will discuss the latest updates to both the False Claims Act and the Anti-Kickback Statute.

• Provide attendees with an understanding of the Federal False Claims Act.
• Provide a perspective of how the courts and the Department of Justice (DOJ) view compliance with the Federal False Claims Act.
• Discuss recent enforcement actions taken by the DOJ.
• Show how the courts deal with violations of the Federal False Claims Act.

• A review of the Federal False Claims Act, its history, how it works, its proof requirements, pleading requirements, and damages.
• New enforcement actions and penalties under the Affordable Care Act.
• A review of recent cases involving the False Claims Act.

Recent cases and/or enforcement actions involving the FCA raise serious concerns regarding compliance issues with hospitals, physician practices, and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.

This session is designed for healthcare executives, attorneys, and consultants who advise health care executives and others who want to learn about the False Claims Act.  The health care executive, physician, or other health care provider, should be very concerned about the potential for enforcement actions under the FCA.  This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced.  Recovery under the FCA last year resulted in over $3.1 billion being recovered for the federal government, $24.2 billion since the law was revised to make it more relator friendly in 1986.

In FY 2020, the Department of Justice (DOJ) opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud-related crimes during the year.  Also, in FY 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year. Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises. In FY 2020, investigations conducted by HHS’s Office of Inspector General (HHS-OIG) resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider self-disclosure matters. HHS-OIG also excluded 2,148 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.

Since 1986, whistleblowers have been awarded nearly $4 billion and whistleblowers are where a majority of the FCA suits originate. Several recent cases involving healthcare providers have resulted in huge settlements.  If that is not enough to get your attention, consider the recent cases finding that the “responsible corporate officer doctrine” allows the government to hold hospital CEOs and others directly responsible for the fraud. In a recent case, executives paid $1 million to settle allegations of fraud and were excluded from participation in federal health care programs.

You will want to attend this webinar to learn how to protect your healthcare providers.

• Hospital executives, particularly CEOs, COOs, CFOs, CNOs, and CMOS
• Other healthcare provider executives
• Healthcare provider board members
• Attorneys representing health care providers and practitioners
• Chief compliance officers