United States health care spending reached $3.6 trillion in 2018, accounting for 17.7% of the gross domestic product. Government officials have been quoted as saying that up to ten percent of this spending is due to fraud, waste, or abuse. In fiscal year 2019, the federal government won or negotiated $2.6 billion in health care fraud and abuse judgments and settlements, as well as additional amounts from administrative cases. As one of the most highly regulated industries in the United States, health care entities are required to comply with numerous statutes and regulations, including those related to fraud and abuse. These laws are increasingly complex, thereby exposing health care entities to liability for non-compliance. Thus, individuals involved in the administration and delivery of health care and lawyers who wish to practice health law must be well-versed in the laws and regulations that govern health care fraud, abuse, and compliance, as well as the strategies health care entities employ to address these concerns.
In this course, students will explore the major federal civil, administrative, and criminal laws that have been used to combat health care fraud and abuse. These laws include the False Claims Act, the Anti-Kickback Statute, the Physician Self-Referral Law, and the Civil Monetary Penalties Law. Related compliance strategies and the practical compliance issues faced by health care providers will also be covered, including the seven elements of effective compliance programs, conflicts of interest and governance, repayments and disclosures, privacy and security, and corporate integrity agreements.