What Keeps You Up At Night?
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1 What Keeps You Up At Night? Issues of Fraud and Abuse Compliance Series Squire Sanders squiresanders.com
2 Squire Sanders squiresanders.com
3 What Keeps You Up At Night? Issues of Fraud and Abuse Compliance Series Squire Sanders squiresanders.com
4 Today s Topic: What I Don t See Coming from the DOJ Interagency task force called HEAT New technology to identify and freeze payments before they are made Government strategies to: Encourage and prosecute more qui tam suits Hold more executives accountable Civil investigative demands and RAC audits An effective compliance program Squire Sanders squiresanders.com 3
5 Today s Speakers David W. Grauer Thomas E. Zeno Joseph Walker Chair, Squire Sanders Healthcare Practice Former Pharmacist with management perspectives Practical and legal perspective to healthcare issues Firm s White Collar Defense & Investigations Practice 25 years as Assistant US Attorney 8 years criminal healthcare fraud prosecutor Former federal prosecutor with DOJ s Criminal Fraud section Chair, Squire Sanders White Collar Defense & Investigations Practice Fraud prosecution and defense work Executive Assistant US Attorney for Operations Squire Sanders squiresanders.com 4
6 In it for the money Squire Sanders squiresanders.com 5
7 H.E.A.T. Health Care Fraud Prevention and Enforcement Action Team DOJ S Motto The HEAT is on Squire Sanders squiresanders.com 6
8 Predictive Modeling Fraud programs like credit card companies No more pay and chase Government will freeze payments, then investigate Squire Sanders squiresanders.com 7
9 False Claims Act The Big Secret Squire Sanders squiresanders.com
10 Relators Can Be: Whistleblowers Former or current disgruntled employees Competitors Squire Sanders squiresanders.com 9
11 In it for the money Squire Sanders squiresanders.com 10
12 Squire Sanders squiresanders.com 11
13 Traditional Fraud Crimes Mail fraud Wire fraud Healthcare fraud Conspiracy Squire Sanders squiresanders.com 12
14 New Creative DOJ Approaches Anti-kickback statute Off-label marketing Charging doctors, nurses and healthcare executives Squire Sanders squiresanders.com 13
15 Investigative Tools Grand jury subpoenas Administrative subpoenas Civil Investigative Demand (CID) 31 U.S.C. 3733(a)(1) It ain t necessarily so Squire Sanders squiresanders.com 14
16 Squire Sanders squiresanders.com Recovery Audit Contractors and Program Safeguard Contractors
17 What Should General Counsel Do? Squire Sanders squiresanders.com
18 What Should General Counsel Do? Establish an effective compliance program Written procedures Risk based Clear lines of authority Get a good compliance officer Squire Sanders squiresanders.com 17
19 What Should General Counsel Do? Provide good compliance training Show commitment at the top to compliance Use discipline and enforcement Conduct internal and external audits Squire Sanders squiresanders.com 18
20 Questions? Squire Sanders squiresanders.com 19
21 Thanks for Joining Our Webinar Join us for future calls in this series: March 15 Keeping Your CEO From Being Excluded May 17 Attorney-Client Privilege: Keeping it and Using it Wisely September 20 How to Handle the Bad or Social Media Post Others Pending: Use of Outside Counsel: When Inside Counsel Is Not Enough Proper Recordkeeping in Heightened Enforcement Environment Squire Sanders squiresanders.com 20
22 Thanks For Joining Our Webinar Contact us with other questions or issues: David Grauer: Joe Walker: Tom Zeno: Squire Sanders squiresanders.com 21
23 What Keeps You Up At Night? Issues of Fraud and Abuse Compliance Series Squire Sanders squiresanders.com
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