Fraud and Abuse: MCO Takeaways from Recent Investigations and Enforcement Activity in the Healthcare Industry

May 3, 2024 9:00am

Kelly Hightower Hibbert
Partner
Crowell & Moring LLP

Jared R. Ginsberg
Counsel
O’Melveny & Myers

Nate Moore
Partner
Robins Kaplan LLP

  • Analyzing how the U.S. ex rel. Schutte v. SuperValu Inc. decision will impact the FCA defense landscape for MCOs
  • Examining the latest kickback schemes involving providers and labs and how they are impacting MCOs
    • Assessing the AKS enforcement landscape involving government programs and commercial plans
    • Implications of the circuit split on FCA based on AKS
  • Identifying trends in fraudulent billing that MCOs need to watch
    • Telehealth, genetic testing
  • Exploring lessons learned for MCOs from notable criminal and civil actions taken by the DOJ
  • Spotlight on investigations into mental health and addictions services
    • Uncovering schemes involving sober living homes