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Fraud and Abuse: Four Cases Tell the Tale


Product Code - LGAU02
Speaker(s): Lisa M. Noller, Foley & Lardner LLP and J. Mark Waxman, Foley & Lardner LLP
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This BNA webinar examines a set of "blockbuster" decisions in the fraud and abuse arena involving hospitals and physicians and the threat of the Stark Law and the False Claims Act ("FCA") to their dealings. Through these four cases we examine the application of the Stark Law and the FCA to closed staff departments, physician acquisitions, and transaction negotiations and dissect the lessons to be learned.

Educational Objectives:

• How to best avoid Stark and FCA liability in physician-hospital negotiations.
• How to recognize warning signs in transaction discussions.
• Learning points with respect to acquisitions and other hospital physician transactions.
• Key training points for negotiators in the physician hospital process
• Addressing challenges in the fair market value appraisal process and how to avoid them

The four cases are:

• United States ex rel. Kosenske v. Carlisle HMA, Inc.
• United States ex rel. Drakeford v. Toumey d/b/a Toumey Healthcare System, Inc.
• United States ex rel. Singh v. Bradford Regional Medical Center
• United States v. Campbell

Lisa M. Noller, Foley & Lardner LLP and J. Mark Waxman, Foley & Lardner LLP

Lisa M. Noller
Partner
Foley & Lardner LLP

Lisa Noller is a litigation partner with Foley & Lardner LLP, where she is a member of the firm’s Health Care, Medical Devices, and Life Sciences Industry Teams, as well as the Government Enforcement, Compliance & White Collar Defense and Business Litigation & Dispute Resolution Practices. She is an experienced trial lawyer, having spent more than 15 years investigating and trying complex criminal and civil cases, including the only Anti-kickback Statute (AKS) jury trials in the Northern District of Illinois. Her practice focuses on managing risk, responding to government investigations, conducting corporate internal investigations, and litigating a wide variety of civil and criminal matters in state and federal courts. Ms. Noller represents companies and individuals in parallel civil and criminal proceedings initiated by government agencies for alleged wrongdoing, and proactively counsels clients in health care enforcement and other litigation matters.

Prior to joining Foley, Ms. Noller was an Assistant United States Attorney in Chicago, where she worked in both the civil and criminal divisions of the office, focusing on numerous complex fraud cases as well as parallel investigations with the Department of Justice and the Securities and Exchange Commission. She was a member of the U.S. Attorney’s team dedicated to the prosecution of health care fraud in Northern Illinois, which worked with the FBI and HHS-OIG to prosecute fraud and abuse and to counsel entities seeking to be compliant with complex regulations. In connection with AKS trials, Ms. Noller submitted and defended pattern jury instructions now used in other AKS cases. Ms. Noller also routinely exercised her discretion in deciding whether to charge or sue individuals or entities suspected of health care fraud, including medical device manufacturers, pharmaceutical companies and hospitals, and worked with other attorneys to make reasonable prosecution decisions.

J. Mark Waxman
Partner
Foley & Lardner LLP

J. Mark Waxman is a partner with Foley & Lardner LLP, where he is former chair of the Health Care Industry Team, and a member of the Government Enforcement, Compliance & White Collar Defense Practice. Mr. Waxman is also a BNA Advisory Board Member.

Mr. Waxman’s health care practice focuses on transactional, regulatory and contractual issues for for-profit and not-for-profit providers and payers. His experience in this area includes issues related to the operation of health care systems, and the integration of health care system participants, policy and regulatory issues for trade associations and strategic business planning. He has a significant history in addressing the antitrust implications of mergers and acquisitions, federal program fraud and abuse, reimbursement and managed care contracting.