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Health Care Fraud Enforcement Trends

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Presentation on theme: "Health Care Fraud Enforcement Trends"— Presentation transcript:

1 Health Care Fraud Enforcement Trends
Patric Hooper Tim Renjilian Hooper, Lundy & Bookman, PC Senior Managing Director 1875 Century Park, East FTI Consulting Suite W Peachtree Street, NW Los Angeles, CA Suite 500 Atlanta, GA 30309 (404) David S. Schumacher Hooper, Lundy & Bookman, PC 470 Atlantic Avenue Suite 1201 Boston, MA 02210 © HLB/FTI, 2017.

2 Trump Administration Health Care Fraud Enforcement Priorities
© HLB/FTI, 2017.

3 Trump Administration Priorities
Commitment to health care fraud enforcement: AAG Blanco comments to ABA. No letdown in enforcement activity Challenges in changing course (aircraft carrier) © HLB/FTI, 2017.

4 Trump Administration Priorities
Opioid Fraud and Abuse Detection Unit 12 districts 12 dedicated AUSAs Pill mills/pharmacies/diversion July 2017 takedown Substance Abuse Clinics © HLB/FTI, 2017.

5 False Claims Act/Qui Tam Developments
© HLB/FTI, 2017.

6 FCA/Qui Tam Escobar Update Recent Circuit Cases
2-part test: mandatory or not? Materiality Defense Opportunities Pleading – Motion to Dismiss Discovery – Government Knowledge © HLB/FTI, 2017.

7 FCA/Qui Tam Managed Care Cases United Health
False claims against Medicare Advantage organizations OC Global Medical Center case DOJ View © HLB/FTI, 2017.

8 FCA/Qui Tam Emboldened Relators
Nonintervention – no longer death knell Consulate/Ruckh trial Long-term/acute/rehab care cases Pressure on DOJ re: seal deadlines Sit on sidelines, file Statements of Interest © HLB/FTI, 2017.

9 FCA/Qui Tam Electronic Health Records HiTech Incentive Program
EClinicalWorks © HLB/FTI, 2017.

10 Kickbacks © HLB/FTI, 2017.

11 Kickbacks Recent Cases and New Theories
Pharma/Charity Investigations HDL settlement/bankruptcy/OIG enforcement © HLB/FTI, 2017.

12 Yates Memo Update © HLB/FTI, 2017.

13 Yates Memo Update Individual Accountability/ Corporate Cooperation
Major Impact: Civil/FCA Cases Recent Examples Ramifications for defense counsel in internal investigations. DAG Rosenstein Comments: Changes on Horizon? © HLB/FTI, 2017.

14 Compliance and Self-Disclousre
© HLB/FTI, 2017.

15 Compliance and Self-Disclosure
60-Day Rule Practical experience with self-disclosures Internal competencies to prepare. Recent DOJ Compliance Guidance © HLB/FTI, 2017.

16 Questions? © HLB/FTI, 2017.

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