2019 Healthcare Fraud Summit Program

Overview of Healthcare Fraud

SSA Harkness will speak on current health care fraud schemes the FBI is currently tracking from an investigators perspective.

The presentation will include brief history of healthcare and healthcare fraud in the US.

Learning Objectives:

Upon completion of this session, learners should be better prepared to:

• Identify healthcare fraud schemes.

Dan Harkness
FBI Supervisory Special Agent,
Healthcare Fraud Unit,
FBI Headquarters, Washington, DC

Daniel Harkness is a Supervisory Special Agent (SSA) in the Health Care Fraud Unit of the Federal Bureau of Investigation (FBI) in Washington, D.C. SSA Harkness holds a Master of Public Administration from Brigham Young University and a Bachelor of Science from the University of Utah with a minor in Economics. He entered New Agent’s Training at Quantico in September 2008. After graduation, he was assigned to the New Haven Field Office, assigned to the Safe Streets Task Force, then to a White Collar (WC) Squad, with an emphasis on healthcare fraud. In April 2014, SAA Harkness was transferred to the Sacramento Field office, to a WC squad working health care fraud violations. In October 2017, he was promoted to FBI Headquarters to work in the Domestic Terrorism Operations Unit. In May 2019, SSA Harkness joined the Health Care Fraud Unit at FBI Headquarters.

Opioids and Healthcare

Dan Harkness

Daniel Harkness is a Supervisory Special Agent (SSA) in the Health Care Fraud Unit of the Federal Bureau of Investigation (FBI) in Washington, D.C. SSA Harkness holds a Master of Public Administration from Brigham Young University and a Bachelor of Science from the University of Utah with a minor in Economics.

Healthcare Fraud:
A Payer’s Perspective

Download Presentation

Learning Objectives:

Upon completion of this session, learners should be better prepared to:

• Define the nature and scope of healthcare fraud
• Discuss why and how healthcare fraud occurs
• Understand federal and state law enforcement environments
• Understand how you can protect your practice

Blake Henson Esq.
Network Integrity Manager
Blue Cross and Blue Shield of Alabama

Mr. Henson has over 8 years of  experience serving in various roles at Blue Cross Blue Shield of Alabama. Most recently he serves in the Legal Services Division as the Manager of Network Integrity where he is responsible for the daily management of staff responsible for the detection, case development and remediation of suspected Fraud, Waste and Abuse. Mr. Henson is a licensed attorney in the state of Alabama.

Opioid Abuse and Healthcare Fraud: A Prosecutor’s Perspective

Prescription opioid overprescribing and related abuse and misuse is dangerous and can be deadly.  Accordingly, combating their incidence is a Justice Department priority.  Medical practitioners who improperly prescribe opioids are often also fraudulently billing health insurance companies for unnecessary tests, and/or prescribing other medically unnecessary drugs, in exchange for kickbacks or some other form of illegal monetary gain.  During this session, the speaker will describe initiatives on the criminal side of the Justice Department to address the ongoing opioid epidemic, the intersection of opioid overprescribing and health care fraud, explain the statutory tools prosecutors are using to deter this conduct, and identify the penalties that exist for violations.

Learning Objectives:

Upon completion of this session, participants should be better prepared to:

• Identify ongoing federal initiatives to address the opioid epidemic and to combat health care fraud;
• Discuss statutes that prosecutors may use to charge medical practitioners and others who overprescribe opioids and commit health care fraud;
• Describe the penalties that violators face.

Chinelo Diké-Minor is an Assistant United States Attorney and Health Care Fraud Coordinator with the Criminal Division of the United States Attorney’s Office, Northern District of Alabama. Ms. Diké-Minor has successfully prosecuted multiple health care fraud and opioid abuse cases. Previously, Ms. Diké-Minor practiced litigation at a law firm in New York, N.Y., and clerked for judges in the District of Connecticut and on the U.S. Court of Appeals for the Second Circuit.

Navigating Qui Tam / Whistleblower Actions

Download Presentation

The False Claims Act is one of the federal government’s primary tools to combat Medicare and Medicaid fraud and abuse. Private citizens may also bring actions under the statute’s whistleblower provisions. Whether based on violations of the Anti-Kickback Statute, violations of the Stark Law, coding issues, documentation issues, or otherwise, healthcare providers may find themselves facing astronomical damages and penalties if they are not careful. Providers should be aware of the pitfalls that may result in liability. During this session, the speaker will explain liability under the False Claims Act, describe the qui tam whistleblower provisions, and give specific examples of situations that may result in liability. An understanding of these elements will assist providers to
avoid and/or prevent possible violations.

Learning Objectives:

Upon completion of this session, learners should be better prepared to:

• Define the elements of the False Claims Act, including penalties and whistleblower provisions
  (knowledge)
• Identify common defenses to False Claims Act allegations (knowledge)
• Demonstrate best practices upon receipt of a government inquiry (competence)

Brad Robertson
Partner
Bradley Arant Boult Cummings LLP

Brad Robertson advises and defends clients facing government investigations and litigations, dealing
with whistleblower allegations and qui tam actions, and planning compliance programs to prevent these occurrences in the first place. He helps his clients navigate compliance and potential liability under the False Claims Act and Anti-Kickback Statute, in addition to other areas of healthcare fraud and abuse and
white collar criminal law.

Sub Lease Agreements and Contract Pitfalls (opening Round Table Discussion)

Download Presentation

The goal of this session is to outline potential risks to consider when negotiating and entering into lease arrangements or other contracts with potential referral sources in light of federal fraud and abuse laws such and the Stark Law or the federal Anti-Kickback Statute.

Learning Objectives:

Upon completion of this session, learners should be better prepared to:

• Identify common areas of risk in a contract with a referral source (knowledge)

Michael D. Tucker
Shareholder
Baker, Donelson, Bearman, Caldwell & Berkowitz PC

Mr. Tucker is a shareholder in Baker Donelson’s Birmingham office. A significant portion of his practice focuses on counseling health care providers and suppliers on corporate/transactional and regulatory matters. His regulatory experience includes advising health care companies and physicians on professional and facility licensure requirements, compliance matters and investigations, and the Federal Physician Self-Referral Law (the Stark law) and the Anti-Kickback Statute (fraud and abuse). In addition, he has broad experience advising drug and medical device companies on clinical research arrangements.

What Makes it “Criminal” – Federal Criminal Healthcare Offenses:
The Fundamentals

Download Presentation

In the heavily regulated and (now) heavily investigated area of healthcare, providers, owners and managers need to know the basic fundamentals of federal criminal statutes which are most commonly prosecuted. During this session, the speaker will provide specific examples and analysis of relevant federal criminal statutes to assist providers in avoiding becoming ensnared in circumstances that could lead to criminal investigation and prosecution.

Learning Objectives:

Upon completion of this session, learners should be better prepared to:

• Identify the basic criminal statutes involved in healthcare prosecutions;
• Respond to allegations or inquiries from law enforcement authorities;
• Distinguish between regulatory/civil investigations and criminal investigations;
• Understand differences and similarities among various types of “contacts” from law enforcement.

James Sturdivant
Shareholder
Sirote & Permutt, P.C.

Jim represents and defends clients in criminal and white collar matters, whether brought by the United States Justice Department, the Alabama Attorney General, the United States Attorney, or local district attorneys. A former federal prosecutor, with an LLM in Tax Law, he represents individuals and corporate clients facing federal grand jury and law enforcement investigations, as well as securities fraud and tax allegations. He assists businesses, professional, governmental, and nonprofit organizations, on strategies to avoid becoming the target of an investigation, and he aggressively represents his clients at trial. In addition to white collar cases, Jim’s state court criminal practice also focuses on alcohol and substance abuse issues. Jim maintains a diverse civil and commercial litigation caseload, and also serves as the Municipal Court Judge for the city of Vestavia Hills.

Legal Round Table

Moderator:
Jeff Dance
Kassouf Healthcare Solutions

Brad Robertson

Jim Sturdivant

Michael D. Tucker