George Breen, Linda Tiano, and Robert Groban, Jr., Members of the Firm, will each speak at the American Health Lawyers Association (AHLA) In-House Counsel Program & Annual Meeting, which runs from June 30 to July 2.
On June 29, Mr. Breen copresents “It’s Not All About the Mandates: Health Care Fraud Enforcement (and Life for the In-House Counsel) in the Age of Health Care Reform.” As we move towards full implementation of the Affordable Care Act, given the Government’s continued spotlight on health care entities over fraud and abuse concerns, knowing where the new land mines are is critical. The Affordable Care Act — and recent government efforts — provide more liability risk, including devoting additional money for enforcement, increasing False Claims Act exposure through expansion of the Medicaid rolls and the creation of the Exchanges, as well as more opportunities for whistleblowers. Topics include:
- The Government is incentivizing quality care: Is more enforcement—through Quality of Care and Medical Necessity investigations and litigations—on the horizon?
- If poor quality can lead to FCA exposure, does peer review factor into the equation? Should providers have potential overpayment concerns whenever there is a “bad outcome”?
- How should quality and medical necessity factor into your fraud and abuse analysis and, if a problem is identified, are there self-disclosure considerations?
Also on June 29, Ms. Tiano copresents “How to Succeed in Business by Really Trying: New Business Opportunities for Providers and Health Plans in the Post-ACA Era.” The health care industry is changing rapidly and drastically. The traditional distinctions between providers, vendors, payers, and employers are becoming less distinct, and all of the industry participants are looking for new ways to work together and new ways to provide services.
- How cost pressures in the health care system are narrowing profit margins for all participants and making efficiency and effectiveness vitally important
- How providers and plans are re-making themselves to address these issues, including examples of projects that have been or are being undertaken and the practical challenges that arise in connection with them
- Additional regulatory concerns and liability exposure that may result from these projects and new lines of business
On June 30, Mr. Groban copresents “Best Practices for a Better Organizational Balance Sheet: How to Assess Risk and Transform Immigration from Liability into Asset.” Topics include:
- The strategic importance of health care immigration under the ACA
- What HR professionals at health care organizations should do to enhance effective recruitment and retention
- Policies and/or procedures that will assist health care organizations to avoid immigration enforcement liability
- How organizations can better manage trends in licensing and credentialing requirements that affect foreign health care workers
- Immigration “due diligence” in a time of heightened health care merger and acquisition activity
On July 2, Ms. Tiano presents “Managing Regulatory Risk in Value-Based Contracting.” Topics include:
- The value-based contracting/innovative payment methods that seek to link payment to quality outcomes, and an examination of the tension between improving quality, controlling costs, and managing a complicated legal/regulatory environment
- New patient care and payment models such as bundled payment methodologies, shared savings pools and other pay for performance strategies
- Legal and regulatory landscape for value-based contracts, including potential fraud and abuse, tax and other state law issues
For more information, please visit HealthLawyers.org.