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Emerging Issues in the Prosecution and Defense of State Medicaid False Claims Cases


Product Code - LGN70
Speaker(s): John Guthrie, National Association of Medicaid Fraud Control Units; Ellyn L. Sternfield, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
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Cases involving false claims submitted to state Medicaid programs are not only becoming more commonly discussed in the press but also more complicated to pursue and settle. Government, defense, and relator’s counsel handling Medicaid-based false claims actions brought under State False Claims Acts (FCAs), or brought pendant to a federal FCA case, must increasingly consider the interests of parties ancillary to the fraudulent conduct who become directly involved in the proceedings, including private counsel hired by State Attorneys General to pursue these cases; health plans which administer Medicaid managed care programs; and consumer or class action counsel who want to claim additional non-FCA damages related to the same conduct.

The faculty for this program will discuss cases involving private counsel retained as special assistant attorneys general, cases involving Medicaid managed care, and cases involving state consumer-based remedies for Medicaid false claims.

Educational Objectives:

• Understand the Constitutional and statutory issues in contracting with private counsel.
• Learn about contingency fee agreements and Federal Medical Assistance Percentages (FMAP) issues.
• Understand the pros and cons of filing motions in a case versus filing a separate lawsuit.
• Learn about challenges in negotiating issues in national Medicaid settlements when some states are represented by private counsel and others are represented by state Medicaid Fraud Control Unit (MFCU) lawyers.
• Find out about state versus managed care contractor responsibility for claims records and data accuracy.
• Learn proper damages calculation and allocation among state, federal government and managed care contractors.
• Understand the impact of the Affordable Care Act.
• Learn about off-label marketing, kickbacks as anti-competitive activities, and coordination of consumer protection and Medicaid FCA cases based on the same conduct.

Program Level: Intermediate.

Credit Available: CLE. For more information, please click on the “CLE Credit” tab.

John Guthrie, National Association of Medicaid Fraud Control Units; Ellyn L. Sternfield, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

John Guthrie, National Association of Medicaid Fraud Control Units
John Guthrie, formerly the Director of the Ohio Medicaid Fraud Control Unit, now serves as a global case consultant with the National Association of MFCUs.

Ellyn L. Sternfield, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
Ms. Sternfield is of counsel in the firm's Washington, D.C. office, practicing in the Health Law Section. She has more than 30 years of legal experience, with an extensive background in the field of government health care enforcement. Her expertise and experience enables her to provide valuable insight to clients facing potential state or federal investigations, or who have general compliance concerns.

Ms. Sternfield currently represents a variety of health care product and service providers in federal and state administrative, civil and criminal matters around the country. She conducts internal reviews and investigations for clients concerned about potential compliance issues and advises clients on proposed or existing health care business arrangements, especially those involving Medicaid, Medicare and the 340B Drug Pricing Program. Ms. Sternfield drafts compliance plans to help insulate clients from future whistleblower claims or enforcement efforts and helps negotiate resolutions of matters brought under federal or state false claims acts.

Ms. Sternfield is dedicated to serving her community, volunteering, and serving on boards at a local level. She currently serves as a member of the Washington University of St. Louis’ D.C. Regional Cabinet and previously served on the board of directors of the Jewish Family and Children Services of Oregon. She also served on the Mittleman Jewish Community Center board of directors, was chairperson of Mittleman Jewish Community Center Kids Corner Committee, and served on the board of advisors for St. Louis Warson House Home for Girls.

Ms. Sternfield earned a J.D. from Washington University School of Law and a B.A., with distinction, from George Washington University. She is actively licensed to practice law in Washington D.C., Missouri, Utah, and Oregon and is admitted to practice in multiple federal and state courts.

This program is CLE-credit eligible.

If you have further questions regarding a specific state or how to file for CLE credit, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to the Legal and Business CLE Accreditation Coordinator.

Hardship Policy
Bloomberg BNA offers a hardship policy for attorneys earning less than $50,000 per year. If an attorney wishes to take advantage of this option, he or she must contact Bloomberg BNA directly. For attorneys who are unemployed or earning less than $35,000 per year, a full discount off the price of the program will be awarded upon written proof of hardship. Attorneys earning between $35,000 and $50,000 per year will receive a 50% discount off the price of the program. Any attorney working in the public service sector also qualifies for a special price. If you have further questions regarding the hardship policy or seek additional information, please contact Bloomberg BNA customer service at 800-372-1033 and ask to speak to Lindsey Pace, CLE Accreditations Coordinator, or email us at accreditations@bna.com.

Questions
For more information about Mandatory or Minimum Continuing Legal Education (MCLE) requirements, visit the American Bar Association website at http://www.abanet.org/cle/mandatory.html.