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FRAUD AND ABUSE LEGISLATION:   AN UPDATE OF THE CURRENT CASE LAW William Mack Copeland
FEDERAL FALSE CLAIMS ACT   ,[object Object],[object Object]
FEDERAL FALSE CLAIMS ACT   ,[object Object],[object Object],[object Object]
QUI TAM CASES FILED  (BY FISCAL YEAR):    ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Total Transfers/Deposits by Recipient FY 2004  $1,756,327,135         TOTAL *** Source:  The Department of Health and Human Services and The Department of Justice,  Health Care Fraud and Abuse Control Program Annual Report For FY 2004,  Sept. 2005. $82,867,287 Relators’ Payments** 13,329,719 13,296,625 12,214,034 7,308,459 5,533,522 3,629,740 3,645,279  $ 58,957,378 Restitution/Compensatory Damages to Federal Agencies Office of Personnel Management Veterans Administration Administration for Children and Families  HHS/OIG Investigative Costs  TRICARE Bureau of Primary Health Care Other Agencies                                    Subtotal 47,358 304,768,588 11,471,529 0 354,205,714 141,350,000 802,659,281  1,614,502,470 Department of the Treasury      HIPAA Deposits to the Medicare Trust Fund             Gifts and Bequests             Amount Equal to Criminal Fines             Civil Monetary Penalties             Asset Forfeiture *             Penalties and Multiple Damages Centers for Medicare and Medicaid Services     OIG Audit Disallowances - Recovered     Restitution/Compensatory Damages                                    Subtotal
False Claims Act Recoveries Approach $16 Billion Since '86 ,[object Object],[object Object],[object Object]
How does the False Claims Act Work   ,[object Object],[object Object],[object Object],[object Object],[object Object]
PROOF OF FALSE CLAIM ,[object Object],[object Object],[object Object],[object Object],[object Object]
FALSE CLAIMS ACT DAMAGES ,[object Object],[object Object]
FALSE CLAIMS ACT ,[object Object],[object Object]
FALSE CLAIMS ACT ,[object Object]
RISK OF FILING A FALSE CLAIMS ACT SUIT ,[object Object],[object Object]
FALSE CLAIMS IN THE HEALTH CARE ARENA ,[object Object],[object Object],[object Object]
Beth Israel Hospital  ,[object Object],[object Object],[object Object],[object Object]
South Shore Hospital,  Miami, FL  ,[object Object],[object Object],[object Object],[object Object]
FALSE CLAIMS AND STARK AND ANTI-KICKBACK ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
STARK I AND STARK II   ,[object Object],[object Object]
STARK I AND STARK II   ,[object Object],[object Object],[object Object]
STARK I AND STARK II ,[object Object],[object Object],[object Object]
STARK PENTALTIES ,[object Object],[object Object]
STARK: CIVIL MONETARY PENALTY  AND EXCLUSION ,[object Object],[object Object],[object Object],[object Object]
STARK EXCEPTIONS ,[object Object],[object Object],[object Object],[object Object],[object Object]
STARK: RECENT CASELAW ,[object Object]
FEDERAL ANTI-KICKBACK STATUTE   ,[object Object],[object Object]
ANTI-KICKBACK EXCEPTIONS ,[object Object],[object Object],[object Object],[object Object]
ANTI-KICKBACK CASELAW ,[object Object],[object Object],[object Object]
ANTI-KICKBACK SAFE HARBORS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OIG JOINT VENTURE ADVISORY OPINION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
KICKBACK RECENT CASES ,[object Object],[object Object],[object Object],[object Object]
KICKBACK RECENT CASES (Continued) ,[object Object],[object Object],[object Object],[object Object]
KICKBACK RECENT CASES (Continued) ,[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICIAN RECRUITMENT :  The Anti-Kickback Safe Harbor   ,[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICIAN RECRUITMENT :  The Anti-Kickback Safe Harbor ,[object Object],[object Object]
PHYSICIAN RECRUITMENT :  The Anti-Kickback Safe Harbor Nine Standards ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICIAN RECRUITMENT :  Stark  Nine Standards ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICIAN RECRUITMENT :  Stark  Payments Indirectly Made ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OTHER FRAUD AND ABUSE LAWS   ,[object Object],[object Object]
OTHER COMPLIANCE ISSUES   ,[object Object],[object Object]
CONCLUSION ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Fraud And Abuse Legislation

  • 1. FRAUD AND ABUSE LEGISLATION: AN UPDATE OF THE CURRENT CASE LAW William Mack Copeland
  • 2.
  • 3.
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  • 5. Total Transfers/Deposits by Recipient FY 2004 $1,756,327,135         TOTAL *** Source: The Department of Health and Human Services and The Department of Justice, Health Care Fraud and Abuse Control Program Annual Report For FY 2004, Sept. 2005. $82,867,287 Relators’ Payments** 13,329,719 13,296,625 12,214,034 7,308,459 5,533,522 3,629,740 3,645,279 $ 58,957,378 Restitution/Compensatory Damages to Federal Agencies Office of Personnel Management Veterans Administration Administration for Children and Families HHS/OIG Investigative Costs TRICARE Bureau of Primary Health Care Other Agencies                                    Subtotal 47,358 304,768,588 11,471,529 0 354,205,714 141,350,000 802,659,281 1,614,502,470 Department of the Treasury     HIPAA Deposits to the Medicare Trust Fund             Gifts and Bequests             Amount Equal to Criminal Fines             Civil Monetary Penalties             Asset Forfeiture *             Penalties and Multiple Damages Centers for Medicare and Medicaid Services     OIG Audit Disallowances - Recovered     Restitution/Compensatory Damages                                    Subtotal
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