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