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The Federal False Claims Act: Enforcement and Recent Updates – Recorded Webinar + Presentation
Recorded Webinar
The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works. It will also provide an assessment of enforcement activities, showing how healthcare providers may be at risk. In addition, the session will review recent cases and show how they potentially impact healthcare providers.
We will start with a review of the Federal False Claims Act and discuss how it works and how it is being used to fight health care fraud. We will discuss how the various health care fraud task forces use the Federal False Claims Act and its whistleblower provisions
to identify and prosecute health care fraud. The webinar will take the Federal False Claims Act apart and show step by step how an action is filed, how the government responds and how the courts interpret various elements of the Act. We will discuss proof, damages under the Act and how the whistleblower is rewarded for bringing a successful case.
The session will also provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as a general review the AKS available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law.
We will also review the changes made to both the False Claims Act and the AntiKickback Statute made by the Affordable Care Act.
Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it. In addition, we will discuss the latest updates to both the False Claims Act and the Anti-Kickback Statute.
Recent cases and/or enforcement actions involving the FCA raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.
This session is designed for healthcare executives, attorneys and consultants who advise health care executives and others who want to learn about the False Claims Act. The health care executive, physician or other health care provider, should be very concerned about the potential for enforcement actions under the FCA. This is important because under recently enacted health care laws, enforcement and health care fraud task forces have been greatly enhanced. Recovery under the FCA last year resulted in over $3.1 billion being recovered for the federal government, $24.2 billion since the law was revised to make it more relator friendly in 1986.
In FY 2020, the Department of Justice (DOJ) opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year. Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises. In FY 2020, investigations conducted by HHS’s Office of Inspector General (HHS-OIG) resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties (CMP) settlements, and administrative recoveries related to provider selfdisclosure matters. HHS-OIG also excluded 2,148 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.
Since 1986, whistleblowers have been awarded nearly $4 billion and whistleblowers are where a majority of the FCA suits originate. Several recent cases involving healthcare providers have resulted in huge settlements. If that is not enough to get your attention, consider the recent cases finding that the “responsible corporate officer doctrine” allows the government to hold hospital CEOs and others directly responsible for the fraud. In a recent case, executives paid $1 million to settle allegations of fraud and were excluded from participation in federal health care programs. You will want to attend this webinar to learn how to protect your healthcare providers.
Venue: Recorded Webinar
Telehealth completely changed in 2020 when the Public Health Emergency was put into effect. Now in 2025, many of those temporary changes are expiring and the telehealth business has exploded. These methods of communication between provider and patient are loved by many, and the convenience of telehealth in healthcare has become a common occurrence. This webinar will be reviewing the current parts of telehealth that are being considered permanent in the 2026 Physicians Fee Schedule Final Rule and the new evaluation and management services that are new codes for CPT in 2025 related to telehealth. We will find out what the do’s and don’ts of telehealth that are here to stay, as well as implementing these new codes and regulations into your practice. These new rules and codes are important to any one currently offering telehealth as well all who are considering it to add it to their practice in order to be compliant and maximize reimbursement for the services performed. Areas Covered in this Webinar The CMS Telehealth List and how to use it Medicare’s rules G codes for Medicare telehealth CPT addition of 17 codes to the E/M section for Telehealth Education for office staff Implementation on your software programs Who Will Benefit Physicians Advanced Nurses Physicians Assistant Billers Coders Compliance Managers Administrators Case Managers Claims Processors
HIPAA Breach Risk Assessments determine whether a Ransomware attack constitutes a HIPAA Breach that triggers Breach Notification Rule reports and notifications. A Ransomware attack is automatically presumed to be a HIPAA Breach unless you do a HIPAA Breach Risk Assessment that demonstrates the attack resulted in only a low probability of compromise to the affected protected health information (PHI). This webinar explains how to do a Ransomware HIPAA Breach Risk Assessment. The Problem Solved by this Webinar The HHS Office for Civil Rights (OCR) declared that a breach of unsecured PHI is presumed to have occurred when electronic protected health information (ePHI) is encrypted as the result of a ransomware attack on a HIPAA-regulated entity (health care provider, health plan, health care clearinghouse, or business associate). The entity must then comply with the applicable breach notification provisions, including notifying affected individuals without unreasonable delay, the Secretary of HHS, and the media (for breaches affecting over 500 individuals), in accordance with HIPAA breach notification requirements. However, it is not a breach if the ransomware-victimized entity can demonstrate that there is a low probability that the encrypted ePHI has been compromised. This webinar explains how to do that. Areas Covered in the Webinar A Breach Risk Assessment can determine whether a ransomware attack is a breach of unsecured ePHI, triggering embarrassing reports and notifications. Factors that can be applied in performing a Breach Risk Assessment. OCR’s guidance about specific factors that can demonstrate a low probability of compromise to ePHI encrypted by a ransomware attack. How to perform a Breach Risk Assessment step-by-step. How to document a Breach Risk Assessment and why you must document it. What to do if you cannot demonstrate a low probability of compromise to ePHI. Why You Should Attend This Webinar Attend this webinar to learn how to perform a Breach Risk Assessment with a special emphasis on ransomware attacks. Ransomware attacks may have only a low probability of compromising ePHI. A Breach Risk Assessment can determine whether a ransomware attack resulted only in a low probability of compromise to ePHI and provide Covered Entities and Business Associates with Documentation to overcome the presumption that the ransomware attack was a Breach.. Who Will Benefit Health Care Covered Entities HIPAA Compliance Officials – Privacy and Security Officers Chief Compliance Officer Practice Managers Health Information Technology Supervisors Risk Managers Group Health Plan Administrators Third Party Group Health Plan Administrators Covered Entity Senior Management and Owners Health Care Providers practicing as individuals or in small groups Attorneys for Covered Entities – In-house and Outside Counsel Business Associates HIPAA Compliance Officials – Privacy and Security Officers Chief Compliance Officer Business Associate Senior Management and Owners Risk Managers Attorneys for Business Associates – In-house and Outside Counsel
Over the last few years, the U.S. Department of Health and Human Services, Office for Civil Rights has made modifications to patient privacy requirements. The agency is on track for enhancing care coordination, empowering patients, and reducing administrative burden. In addition, on the Security Rule side, the agency released a proposed rule to overhaul significant requirements and make cybersecurity safeguards a priority. Knowing what an organization must do to meet these new regulatory requirements can be challenging. The webinar will address what has already changed in privacy, cover proposed Privacy Rule modifications, and cover the Security Rule overhaul proposals. Timeline and compliance implications will be covered. After completing this webinar, a Covered Entity or Business Associate will have a clear understanding of what has changed and what will change. Objectives Who Must Comply with HIPAA Requirements? What are the HIPAA Security and Privacy Rules? What Has Already Changed in Privacy? What are the Proposed Privacy Rule Modifications? What are the proposed Security Rule modifications? What is the Timeline & Compliance Implications? What recommendations should be followed now? Q&A Webinar Highlights Learn from an expert on the implementation of the HIPAA rules Understand what the HIPAA management process currently requires Learn how to implement these changes for your organization Who Should Attend Compliance Officer HIPAA Privacy Officer HIPAA Security Officer Medical/Dental Office Managers Practice Managers Information Systems Manager Chief Information Officer General Counsel/lawyer Practice Management Consultants Any Business Associates that access protected health information
Many providers have considered outsourcing functions in the revenue cycle. Like all businesses, some third-party companies do excellent work for providers, but there may be others that look for ways to take advantage of their provider. Outsourcing has its own pros & cons that must be carefully considered. We will review major common areas that providers must weigh strategically before making a decision whether to outsource and selecting the best partner for your needs. It is vital providers know exactly who is handling their claims and what they are doing with their information. Definitions of third-party vendors Legal responsibilities of the provider Common industry trends Important questions to ask vendors & contractors Who Will Benefit Physicians Practice managers Medical assistants Nurses Compliance staff Billers Coders Revenue Cycle Risk Management Mid level providers