Pedorthic Footcare Association’s 54th Annual Symposium & Exhibition: It Really IS All About Quality … The Government’s Pursuit of Medical Necessity and Quality of Care Cases

John B. Hynes Veterans Memorial Convention Center

Boston, Massachusetts

George B. Breen, Member of the Firm and Chair of the National Health Care and Life Sciences Steering Committee, will present a keynote address, "It Really IS All About Quality ...The Government's Pursuit of Medical Necessity and Quality of Care Cases," at the Pedorthic Footcare Association's 54th Annual Symposium & Exhibition, which runs from October 31 to November 2.

A description of Mr. Breen's keynote:

As you assess your risk exposure for government enforcement, there is increasing concern with the government's pursuit of quality of care and medical necessity cases. Clearly, the pursuit of healthcare providers is at an all-time high — just in February of this year, the Department of Health and Human Services (HHS) and Department of Justice (DOJ) reported recoveries of $4.2 billion for FY 2012 in False Claims Act settlements and judgments, as well as healthcare fraud administrative actions.

Recently, HHS and DOJ announced that they were teaming up with private insurance organizations in pursuit of healthcare fraud. Reportedly, this will include a sharing of information for the purposes of detecting and preventing payments for allegedly unlawful or fraudulent healthcare billings — putting a spotlight on medical necessity issues. MAC and ZPIC auditors are already focusing their sights in this arena.

Moreover, certain federal healthcare programs require adherence to standards of quality, including the measurement and reporting of quality indicators making quality of care a likely target of increased enforcement efforts.

Learning Objectives:

  1. Review the government's theory of liability in "quality of care," "worthless services," and "medical necessity" cases against providers.
  2. Learn how to challenge and defend against the government's enforcement efforts.
  3. Learn what providers can do proactively, and how compliance programs should be adapted to address these heightened risk areas.

For more information, visit the Symposium's website.