NEW YORK, Dec. 5, 2014 (GLOBE NEWSWIRE) --
Moses & Singer LLP attorney Lauren Mack, Partner in the firm’s White Collar Criminal Defense and Government Investigations practice, addressed healthcare executives and their advisors at a seminar entitled, “Healthcare Fraud Enforcement” on December 2, 2014. The seminar focused on regulatory requirements and potential risks faced by healthcare providers serving patients enrolled in Medicare and Medicaid.
“The Affordable Care Act provides $350 million over the 10 years to step up enforcement efforts against alleged fraud, waste and abuse of Medicare and Medicaid,” notes Lauren. As a former Executive District Attorney and Chief of the Kings County Healthcare Fraud Unit who recovered over $10 million in fraudulent claims, Lauren spoke first hand regarding the serious nature of these allegations.
“Providers with conflicts of interest who make medical decisions that aren’t firmly rooted in what’s best medically or financially for their patients will be exposed in the future,” Lauren observed. False claims – which can generate treble damages – often result from: kickbacks, overpayments, self-referrals, unapproved uses, upcoded or unbundled procedures, or performing unnecessary procedures. Driving up the number of visits, ordering questionable tests or prescribing controlled substances can prompt “red flags” as well. The red flag list is part of a fraud-prevention audit Moses & Singer offers to the firm’s clients.
Whistleblowers can also come forward with accusations of fraud. Whistleblower rewards - up to 30% of the claim - present a lucrative opportunity for disgruntled or former employees and even patients.
Providers with lax supervision will face substantial risk if they allow such practices, either intentionally or unintentionally. Business as well as personal assets may be subject to penalties. Providers should consult with financial and legal advisors to determine the need for trusts or any other protection strategy.
Other speakers at the program discussed the ins-and-outs of investigations and how the Medicare Strike Force is organized to fight fraud, waste and abuse.
What happens once an organization gets served with a subpoena? The session covered the relevant statutes, indictment process, search warrant process and strategies for defense. “Due to the high stakes involved, make sure to involve professionals with deep experience in this area,” Lauren cautioned, but “remember that forewarned is forearmed. Building a culture of compliance is the key to a successful defense.”
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