United States health care spending reached $3.2 trillion in 2015, accounting for 17.8% of the gross domestic product. Government officials have been quoted as saying that up to 10 percent of the money the United States spends on healthcare is due to fraud, waste, or abusive practices. If true, that now amounts to over $3 billion per year. In Fiscal Year 2016, the federal government won or negotiated over $2.5 billion in health care fraud judgments and settlements, as well as additional amounts from administrative cases. Thus, health care fraud is a major priority of both federal and state agencies and lawyers who wish to practice health law would be wise to understand the laws that govern health care fraud and abuse.
This course focuses on the major civil, administrative and criminal laws that have been used to combat health care fraud and abuse, broadly defined as actions by health care providers (e.g., hospitals, physicians and physician practices, nursing homes, medical device and pharmaceutical manufacturers, home health agencies, clinical laboratories, and rehabilitation facilities) that are inconsistent with accepted business and medical practices. These laws include the federal civil False Claims Act, the federal Anti-Kickback Statute, the Stark Law, and the Civil Monetary Penalties Law. While the class focuses on federal law, health care fraud and abuse laws at the state level will also be discussed. Related compliance strategies and the practical compliance issues faced by healthcare providers will also be covered.