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Fraud and Abuse 2017: Game-Changing Trends (And Strategies to Avoid FCA Actions)


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

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In fiscal year (FY) 2016, the Department of Justice (DOJ) recovered $2.5 billion from healthcare fraud cases, marking the seventh consecutive year that healthcare civil fraud recoveries exceeded $2 billion. Between January 2009 and the end of FY 2016, the DOJ recovered $19.3 billion in healthcare fraud claims--and these figures represent just federal dollars. In many cases, the DOJ was instrumental in recovering additional millions of dollars for state Medicaid programs.  And the states continue to bring their own healthcare fraud cases.

Every healthcare segment is finding itself in the government’s crosshairs as enforcement tightens.  In the past year, healthcare fraud claims have been brought against, among others, the drug and medical device industries, hospitals and outpatient clinics, medical labs, and nursing home and skilled nursing facilities.

In a new webinar, Manatt examines the growing use of the False Claims Act (FCA) as an enforcement tool and other enforcement trends—including increasingly aggressive techniques, from predictive modeling to wiretaps—making the healthcare landscape more perilous than ever before in history.  The session will explore the most significant FCA cases and their implications, including the Escobar decision…the newest rules around whistleblowers…current trends in recoveries and what’s next…and the innovative enforcement techniques that are changing the game.  In addition, participants will learn strategies for protecting their organizations, as the industry endures growing levels of scrutiny—including how to build effective compliance programs and what to do if faced with a government investigation.

Educational Objectives:
Participants will have the opportunity to: 
• Look at the types of FCA violations being investigated for each healthcare segment.
• Examine the implications of the Escobar decision on implied false certification, materiality and FCA cases moving forward.
• Explore other key FCA cases that are remapping the fraud and abuse landscape—and the decisions to watch for in the year ahead.
• Analyze the impact of recent DOJ cases on decisions relating to Medicare Advantage.
• Learn the enhanced provisions that are increasingly common in Corporate Integrity Agreements (CIAs).
• Find out how to build compliance programs that protect your organization in today’s complex enforcement environment.
• Gain guidance on how to respond effectively to a government investigation.

Who would benefit most from attending this program?
In-house and outside counsel, compliance officers and directors, and senior executives for pharma, device and biotech companies; hospitals and health systems; insurers; long-term care, nursing home and skilled nursing facilities; and medical labs.

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Jacqueline Wolff
  • Partner
  • Co-chair, Corporate Investigations and White Collar Defense, and Co-chair, False Claims Act Practice

Jacqueline C. Wolff is co-chair of the Corporate Investigations and White Collar Defense group of Manatt, Phelps & Phillips, LLP in the firm’s New York office. She has spent over 30 years defending companies and individuals accused of white collar crimes and False Claims Act violations. A former Chief of the Environmental Crimes Unit and Assistant United States Attorney for the Frauds Division in the District of New Jersey, Jacqueline focuses her practice on violations of the Foreign Corrupt Practices Act (FCPA), fraud-based crimes including healthcare, securities and tax fraud, and immigration crimes. She has successfully defended multiple 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. Jacqueline has also represented corporate clients ranging from Fortune 100 companies to small venture capital firms in FCPA investigations and criminal immigration matters. She has successfully represented corporate officers in tax and securities fraud matters.

While in the United States Attorney's Office, Jacqueline received numerous awards, including those from the Immigration and Naturalization Service, the U.S. Nuclear Regulatory Commission, the U.S. Environmental Protection Agency and the Attorney General of the United States.

Jacqueline received her J.D. from Fordham University School of Law and her B.A. from the University of Pennsylvania.

Richard S. Hartunian
  • Partner
  • Corporate Investigations and White Collar Defense, Manatt, Phelps & Phillips, LLP

Rick defends companies against allegations of white collar crime, healthcare fraud and environmental violations, and advises on cross border security and trade issues, as well as cybersecurity, employment and defense procurement matters. He also helps clients manage crises that result from litigation and government enforcement efforts, particularly when investigations involve multiple agencies and jurisdictions.During his tenure as United States Attorney for the Northern District of New York, Rick headed several key initiatives and prosecutions. He strengthened his office s Civil Division, emphasizing affirmative civil enforcement to combat healthcare and procurement fraud, and he worked closely with the FBI and U.S. Department of Homeland Security on cybercrime, including trade secret and customer data theft. Rick now advises companies that are under scrutiny by the government or are victims of cyberattacks by criminal organizations or state actors and provides counsel on preemptive measures.Rick has substantial knowledge of and good working relationships with U.S. and Canadian border security agencies, enabling him to assist U.S. and Canadian businesses that have pressing border related concerns. Rick also has experience with Native American tribal affairs and gaming matters.Frequently interviewed by the legal press, Rick is also regularly invited to address both public and private organizations, including county, state, federal and national bar associations.

Randi Seigel
  • Counsel
  • Manatt Health

Randi Seigel s practice focuses on advising hospitals and health systems, home health agencies, long term and post acute care providers, payers and other healthcare stakeholders on privacy, compliance and regulatory issues. She provides legal and strategic guidance across a variety of critical areas, including the Health Insurance Portability and Accountability Act HIPAA , the Affordable Care Act ACA , Medicare and Medicaid conditions of participation and billing, fraud and abuse, and compliance program requirements.Randi came to Manatt from the Visiting Nurse Service of New York VNSNY , where she was head compliance officer and privacy officer for VNSNY s family of corporations, including certified and licensed home care service agencies, hospice, behavioral health providers, a captive professional corporation, New York State Medicaid managed long term care plan, Medicare Advantage Plan and a health home. In that role, she created and implemented an enterprise wide compliance program that improved oversight, engagement and reporting. In addition, she advised on regulatory constraints and risks associated with strategic objectives and reorganizations, including partnerships with hospitals and ACOs. She also assessed and monitored progress on areas of regulatory exposure, as well as enhanced processes for Code of Conduct Fraud, Waste and Abuse and HIPAA training.Randi first joined VNSNY as associate general counsel and also served as the interim provider compliance officer. Her responsibilities included providing legal and regulatory counsel on HIPAA, the Family Health Care Decision Act, ACA and the Anti Kickback Statute drafting and negotiating contracts to support geographical expansion, improve operations and enhance compliance and counseling staff on patient and care delivery issues.Prior to VNSNY, Randi was a healthcare associate at Garfunkel Wild, P.C. She represented hospitals, home health agencies, physician practices, pharmacies and Federally Qualified Health Centers FQHCs in corporate and regulatory compliance, including researching Medicare and Medicaid billing, reimbursement and fraud and abuse concerns evaluating state and federal licensure issues and responding to Medicare and Medicaid audits and investigations.

Continuing Education

COA, 1.5 CLE
A basic understanding of the False Claims Act FCA .
Production Date: