Fraud and Abuse 2016: Game-Changing Trends and Cases (and How to Protect Your Organization)

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This is a complimentary program sponsored by Manatt, Phelps & Phillips, LLP. 

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In 2014, the Department of Justice recovered $2.3 billion from healthcare fraud cases, marking the fifth straight year the Department recovered more than $2 billion from cases involving false claims against federal healthcare programs, such as Medicare, Medicaid, and TRICARE.  From January 2009 through the end of the 2014 fiscal year, the department used the False Claims Act (FCA) to recover $14.5 billion in federal healthcare dollars.  And these amounts reflect federal dollars only.  In many of these cases, the DOJ was instrumental in recovering additional billions of dollars for consumers and states. Clearly, every segment of the healthcare industry is enduring greater levels of scrutiny.  While the focus has historically been on pharmaceutical and medical device manufacturers, surgeons, insurers, and long-term care facilities, other segments now are finding themselves in the crosshairs.  For example, cases involving hospitals resulted in $333 million in settlements and judgments in 2014.

In a new webinar, Manatt examines the growing use of FCA as an enforcement tool and other enforcement trends – including the use of increasingly aggressive techniques, such as video surveillance and wiretaps, making the healthcare landscape more perilous than ever in history.  The session will explore key FCA provisions – and explain how the Affordable Care Act (ACA) introduced both heightened penalties for healthcare organizations and additional incentives for whistleblowers.  It also will take a close-up look at the major FCA cases that are re-mapping the fraud and abuse landscape and the decisions to watch for in 2016. The webinar then will guide participants in building effective compliance programs that protect their organizations in today’s stringent and complex enforcement environment.  Attendees will learn both how to avoid FCA actions – and what to do if the government does come calling.  The session will share concrete steps for protecting their organizations, as well as for responding effectively if they do face a government inquiry.

Educational Objectives:
• Track the growth in FCA recoveries – and what’s anticipated in months to come.
• Look at the new healthcare stakeholders facing FCA cases – and the types of violations being investigated for each segment.
• Gain an understanding of FCA definitions, provisions, and penalties.
• Explore key FCA cases and their impact.
• Examine the latest enforcement trends, including the use of predictive modeling, videotaping, wire and securities fraud, and more.
• Learn the enhanced provisions that are increasingly common in Corporate Integrity Agreements (CIA).
• Discover how the ACA raised the stakes.
• Hear the new rules and incentives around whistleblowers.
• Find out how to build compliance programs that protect your organization.
• Gain guidance on how to respond effectively, if a government investigation happens.

Who would benefit most from attending this program?
In-house or outside counsel for any healthcare-focused organization, including life sciences companies, hospitals, health systems, payers/insurers, long-term care facilities and labs; compliance officers/directors; executives of healthcare organizations who want to ensure their organizations are protecting against FCA action.

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Mr. Arun Bhoumik is a partner in the firm’s New York office and a member of the Litigation Division.  His practices focuses on corporate defense and investigations and commercial litigation.  Mr. Bhoumik has represented numerous individuals and companies in investigations by federal and state authorities in the areas of health care fraud, securities fraud and public corruption. Prior to joining the firm, Mr. Bhoumik served as a federal prosecutor in the Fraud section of the U.S. Department of Justice, Criminal Division. In this position, he investigated and prosecuted matters involving fraud, false claims, money laundering, and violations of the Anti-Kickback Statute, primarily in the health care industry.  Mr. Bhoumik previously served as a law clerk to the Honorable Stephen C. Robinson, U.S. District Court for the Southern District of New York, and worked as an associate at Cravath, Swaine & Moore LLP. Mr. Bhoumik is admitted to practice in New York.  He earned his J.D., cum laude, from Harvard Law School and his B.A., summa cum laude, from Binghamton University.


Ms. Jacqueline Wolff is the Co-chair of Manatt's Corporate Investigations and White Collar Defense Group.  She has spent over 25 years defending companies and individuals accused of white collar crimes and False Claims Act (FCA) violations. A former Chief of the Environmental Crimes Unit and Assistant United States Attorney for the Frauds Division in the District of New Jersey, Ms. Wolff has successfully defended multiple life sciences and healthcare clients in False Claims Act cases resulting in declinations from the government, resolutions as overpayment cases or, where the government decided not to intervene, outright dismissals of the qui tam complaints.
While in the United States Attorney’s Office, Ms. Wolff received numerous awards, including from the Attorney General of the United States. Ms. Wolff serves on the Advisory Board of Bloomberg BNA’s Pharmaceutical Law and Industry Report and the Board of Directors of the New York County Lawyer’s Association.  She is also a member of the Board of Editors of the Business Crimes Bulletin.


Robert Hussar has over 15 years of experience in the public and private sectors, providing advice and strategic direction on Medicare, Medicaid and other payer regulatory, compliance and reimbursement issues.  He counsels providers, boards of directors and other healthcare stakeholders on the development and implementation of compliance programs, performs compliance due diligence and effectiveness reviews, provides interim compliance services, conducts internal investigations, and provides representation for Medicare and Medicaid regulatory matters, including self-disclosures, audit defense, and settlement negotiations. Mr. Hussar previously served as the First Deputy for the New York State Office of the Medicaid Inspector General (OMIG), where his role included strategic planning and leadership for New York's $50 billion Medicaid program.  He was directly responsible for the implementation of mandatory provider compliance plans and corporate integrity agreements, and he chaired provider advisory committees focused on compliance guidance, self-disclosures and OMIG's audit processes. Most recently Mr. Hussar was a Senior Manager with a global accounting and consulting firm, where he focused on the design, implementation and improvement of provider and payer compliance programs and state program integrity units.  Prior to his service with OMIG, he was the Compliance Officer at Northeast Health, where he led the oversight and facilitation of systemwide compliance efforts for the health system and its approximately 15 affiliates, including acute and rehabilitation hospitals, skilled nursing facilities, home healthcare, physician practices, a durable medical equipment provider and a Program of All-Inclusive Care for the Elderly. Mr. Hussar is admitted to practice in New York.  He earned his J.D. from the Western New England College School of Law, his M.S. in Health Systems Management from Union College, and his B.A. from Union College.