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Fraud and Abuse

 
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Welcome to the Fraud and Abuse Practice Group (FA PG). We help you stay informed about fraud and abuse compliance issues and developments in enforcement activity.

Here are the top four things you can do to make the most of your membership in the FA PG:

  1. Register for a webinar or listen to an archived webinar: Web-based seminars focus on a wide range of topics related to fraud and abuse issues and regulations.  Click here to access a list of upcoming and past webinars sponsored by the FA PG.
  2. Join a Community: The AHLA Communities are a collection of online discussion lists that offer a forum for dialogue and encourage groups of members to connect with one another on topics that interest them most. To join a Community, visit your "myAHLA" profile at www.healthlawyers.org/myahla, enter your login information, click the blue button to customize your "Email and List Preferences," and click "Save."
    •  The Compliance Community focuses on regulatory compliance with a strong emphasis on the design and implementation of compliance programs.
    •  The Stark Law Community is the place to discuss Stark Law interpretative issues and guidance about approaches to resolving Stark Law compliance problems.
  3. Check out the FA PG Topical Library: This is where you can access the most relevant and recent AHLA publications and resources related to your practice area. It's the hub for AHLA content on FA. 
  4.  Plan to attend the Fraud and Compliance Forum (held every September in Baltimore, MD): This program brings together legal counsel, compliance officers, and government representatives for an invaluable learning and networking opportunity. It covers Stark, False Claims Act, Anti-Kickback Statute, and the enforcement efforts in these areas, and address emerging regulatory trends, recent case law and legislative developments, and how they will affect legal and compliance practices in health care.

In addition, here are other benefits available to you through the FA PG:

  • Email Alerts, Executive Summaries, and Member Briefings: Timely alerts are delivered directly to your inbox—when a new law, regulation, or decision is published, we do the initial legwork and summarize it for you.
  • Resources and Toolkits:  FA PG members have access to toolkits on the Anti-Kickback Statute, Stark Law, and real estate lease issues, as well as state law fraud and abuse surveys.   
  • Great Opportunities for Involvement: The FA PG leadership welcomes and encourages members to become active participants by writing, speaking, tweeting, serving as a mentor, and taking on other leadership roles. Visit www.healthlawyers.org/volunteer to view available volunteer opportunities.
  • Task Forces: For those health law topics that cross over several Practice Groups, AHLA has established Task Forces that produce collaborative, substantive resources for the benefit of the sponsoring Practice Groups' members. FA PG members are automatically enrolled in

o   Accountable Care Organization, Payment Innovation, and Health Care Reform Educational Task Force: This group provides members with a variety of information and resources relating to accountable care organizations, integrated care models, and other health care reform initiatives designed to improve quality and lower costs, for better population health.

o   Behavioral Health Task Force: This group monitors and evaluates these laws and developments through written materials, webinars, and in-person educational activities so that AHLA members are better equipped to advise clients on behavioral health topics.

Providing legal and compliance guidance in the health care industry requires you to understand the many complex legal issues raised by the ever-evolving fraud and abuse landscape. We hope that your active participation in the FA PG will help you meet your clients' needs.


 
Summaries of the Office of Inspector General (OIG) Advisory Opinions are provided by the Advisory Opinions Task Force of the Fraud and Abuse Practice Group. The Task Force aids Practice Group members in keeping abreast of new Advisory Opinions. For each new opinion issued by the OIG, a summary is released via an email alert and posted on several Practice Groups' websites.

You may access this content by joining AHLA and enrolling in Fraud and Abuse Practice Group.


Already a member? Sign in

You may access this content by enrolling in Fraud and Abuse Practice Group.

You may access this content by Renewing your membership for Fraud and Abuse

You may access this content by joining AHLA and enrolling in Fraud and Abuse Practice Group.


Already a member? Sign in

You may access this content by enrolling in Fraud and Abuse Practice Group.

You may access this content by Renewing your membership for Fraud and Abuse

You may access this content by joining AHLA and enrolling in Fraud and Abuse Practice Group.


Already a member? Sign in

You may access this content by enrolling in Fraud and Abuse Practice Group.

You may access this content by Renewing your membership for Fraud and Abuse


You may access this content by joining AHLA and enrolling in Fraud and Abuse Practice Group.


Already a member? Sign in

You may access this content by enrolling in Fraud and Abuse Practice Group.

You may access this content by Renewing your membership for Fraud and Abuse

  • Anti-Kickback Statute Toolkit
    - Published on April 15, 2016; Updated on December 11, 2018
    This Toolkit collects a broad array of primary source materials concerning the AKS. The resources include: the statute; implementing regulations; guidance from the U.S. Department of Health and Human Services Office of Inspector General (OIG); Advisory Opinions issued by OIG; and key case summaries from each of the federal circuits. Quick summaries of certain materials are provided to enable users to quickly identify and sort through the available resources. The Toolkit is intended to assist research activities, but may not be a fully comprehensive set of all relevant AKS materials. The Toolkit will be updated periodically as the AKS and interpretive documents change or become available.

  • Stark Law Toolkit
    - Published on April 24, 2018
    The Stark Law Toolkit aggregates all the significant rulemaking from 1992 to the present, including questions and CMS commentary, in one searchable portfolio. The Toolkit also includes an index covering every Stark Law exception. For example, an attorney researching the rental of office space exception at §411.357(a) can turn to the index to find citations to every substantive discussion of the exception across all applicable Federal Register issuances. In addition, each citation directly links to the corresponding page in the Toolkit portfolio. If the attorney is researching a topic that is not covered in the index, e.g., the definition of “interoperable,” she can perform a word search of the entire portfolio to find every instance of the search term.

  • Health Care Real Estate Lease Toolkit
    - Published on January 16, 2015; Updated on February 9, 2016
    This Toolkit is designed to assist counsel in structuring legally compliant hospital-physician real estate leases by organizing relevant resources in one convenient location. It places particular focus on the FMV and commercial reasonableness standards and the technical requirements for leases under the applicable safe harbors and exceptions to the Anti-Kickback Statute and Stark Law. The Toolkit is structured as a compilation of the relevant statutes, implementing regulations, interpretative agency commentary, advisory opinions, and case law materials. The Toolkit also provides general considerations when engaging a third-party valuation consultant to document compliance with the FMV and commercial reasonableness standards.

 
Fifty-State Survey
- Updated on September 7, 2018
This survey is a collection of summaries of state health care fraud and abuse statutes, regulations, and other pertinent authorities such as the rules governing the practice of medicine.
​This is a members-only, web-based reference tool that features substantive practice development information focusing on the False Claims Act and other government matters. Designed to bring timely, practice-oriented data to Fraud and Abuse Practice Group members, categories of information on this site range from current negotiating issues with the Department of Justice on False Claims Act cases to seminal cases. The Practice Corner provides practice points and other information and is not restricted to defense perspectives. The Practice Corner presents practice information that is helpful for all practice areas.

You may access this content by joining AHLA and enrolling in Fraud and Abuse Practice Group.


Already a member? Sign in

You may access this content by enrolling in Fraud and Abuse Practice Group.

You may access this content by Renewing your membership for Fraud and Abuse

Upcoming:

Past:

Upcoming:

Past:

Upcoming:

Past:

February 9, 2016 12:00 PM-1:15 PM Eastern

Upcoming:

December 13, 2018 3:00 PM-4:00 PM Eastern

Past:

October 12, 2018 12:00 PM-1:00 PM Eastern
June 6, 2017 1:00 PM-1:30 PM Eastern
May 30, 2017 1:00 PM-1:30 PM Eastern
April 18, 2017 1:00 PM-1:30 PM Eastern

Task Forces

Task Forces are established for those health law topics that cross over several Practice Groups, and they provide collaborative, substantive resources for the benefit of the sponsoring Practice Groups' members.
Please note: You must be a member of the Fraud and Abuse Practice Group or one of the other sponsoring Practice Groups to receive benefits produced by these Task Forces.

  • Accountable Care Organization Task Force
    The mission of the ACO Task Force is to provide members with a wide array of information relating to accountable care organizations, integrated care models, and other initiatives designed to improve quality and lower costs, for better population health. The ACO Task Force analyzes the impact and trajectory of ACO and other integrated care developments nationwide, including commercial ACOs, Medicaid ACOs, and the Medicare ACO programs.

    The mission of the ACO Task Force includes informing members of any new or updated regulations, waivers, and guidance relating to the main federal ACO programs, including the Medicare Shared Savings Program and the Pioneer ACO program, as well as to provide information on a broader array of issues integral to ACOs, integrated care systems, population health, and payment models.

    The ACO Task Force provides webinars, written material, and sponsored in-person programming pertaining to the relationship between ACOs and population health, as well as other topics germane to ACO formation and development. Since the ACO Task Force mission is so broad, it often partners with other AHLA Practice Groups to provide deeper insight into the unique legal and policy considerations for ACOs.
  • Behavioral Health Task Force
    The Behavioral Health (BH) Task Force is committed to advancing the understanding of laws impacting behavioral health, including the delivery of services to those living with mental illness, certain neurological conditions, substance use disorders or developmental disabilities, and reimbursement for such services. A complex framework of federal and state laws concerning privacy, information sharing and exchange, reimbursement, involuntary commitment, and other subjects provides unique challenges to health care providers and payers of behavioral health services. Scientific, legislative, and other developments, including health care reform, have presented new issues and opportunities in this area, including primary and behavioral health care integration initiatives, insurance coverage parity mandates, changes to Medicaid, and evolving public policy, to name a few. The BH Task Force monitors and evaluates these laws and developments through written materials, webinars, and in-person educational activities so that AHLA members are better equipped to advise clients on behavioral health topics. In addition, the work of the BH Task Force serves to raise awareness about how behavioral health laws influence health improvement efforts, and will include collaborative efforts with AHLA's Public Interest activities.

  • Webinars

    Roundtable Discussions


    Image of GaryHerschman
    Gary W. Herschman Chair Epstein Becker & Green PC Newark, NJ (973) 639-5237 Email
    Image of JacquelineBaratian
    Jacqueline C. Baratian Vice Chair - Research & Website Alston & Bird LLP Washington, DC (202) 239-3484 Email
    Image of JosephKahn
    Joseph M. Kahn Vice Chair - Publications Hall Render Killian Heath & Lyman PC Morrisville, NC (919) 447-4966 Email
    Image of TonyMaida
    Tony R. Maida Vice Chair - Membership McDermott Will & Emery LLP New York, NY (212) 547-5492 Email
    Image of CaitlinMcCormick-Brault
    Caitlin Suzanne McCormick-Brault Vice Chair - Educational Programs Columbia, MD Email
    Image of KevinRaphael
    Kevin E. Raphael Vice Chair - Strategic Planning and Special Projects Pietragallo Gordon Alfano Bosick & Raspanti LLP Philadelphia, PA (215) 988-1442 Email
    Image of JacobHarper
    Jacob Harper Social Media Coordinator Morgan Lewis & Bockius LLP Washington, DC (202) 739-5260 Email

     

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