Healthcare Cos. Face Onset of Tough New Anti-Fraud Rules, Warn LeClairRyan Attorneys

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Free webinar by national law firm’s Affordable Care Act practice team brings healthcare providers up to speed on anti-fraud focus of Obamacare.

A two-hour webinar by members of LeClairRyan’s Affordable Care Act (ACA) practice team provides a comprehensive overview of the tough new anti-fraud provisions coming online thanks to Obamacare. The webinar, titled “Summary of the Anti-Fraud Provisions of the Affordable Care Act,” originally aired Aug. 21 and is now available as a free download at

“Despite all of the rumors and myths regarding delays, postponements and even repeal of Obamacare, much of this landmark legislation is already in place, and the rest is on the way,” said Patrick J. Hurd, a senior counsel in LeClairRyan’s Norfolk, Va., and Washington, D.C. offices. “In particular, this means that licensed healthcare providers—anyone from doctors, nurses, physical therapists and psychologists, to proprietors of hospices, home-health agencies and nursing homes—are in the crosshairs of the government’s aggressive campaign to prevent and reduce fraud and abuse. The onus is on the industry to prepare and respond to these changes.”

Toward that end, the webinar by LeClairRyan’s ACA team offers a detailed exploration of ACA’s anti-fraud provisions and their potential implications for healthcare providers. In addition to Hurd, the presenters include veteran litigators Michael F. Ruggio, Healthcare Industry Team Leader and shareholder in the national law firm’s Washington, D.C., office, and Sarah Reimers McIntee, a Washington-based associate.

The webinar begins with an overview of the enforcement landscape, including a thorough description of new tools created by ACA that are designed to prevent, detect and take strong enforcement action against fraud in Medicaid, Medicare and other private insurance offerings.

“With regard to funding these efforts, ACA provides $350 million over a 10-year period, and it specifically allows these funds to be used for the hiring of new officials and agents who can help prevent and identify fraud,” Ruggio says. “Obamacare also allows the Centers for Medicare and Medicaid Services to conduct background checks, site visits, and other enhanced oversight to weed out fraudulent providers before they starting billing the program.”

The ACA’s national, pre-enrollment screening program for all providers requires that applicants disclose any prior associations with delinquent providers or suppliers, Ruggio adds. “States will have to screen providers to determine if they have a history of defrauding government,” he says. “Those types of providers and suppliers that have been identified in the past as posing a higher risk of fraud—such as durable medical equipment suppliers—will be subject to a more thorough screening process.”

During the webinar, Ruggio also outlines how new penalties and better data-sharing among government agencies stand to affect healthcare providers.

In her portion of the presentation, meanwhile, McIntee offers an analysis of the differing ways in which ACA’s anti-fraud provisions are likely to affect specific sectors such as hospices, nursing homes, home-health agencies and skilled nursing facilities.

The aforementioned new enforcement tools are coming online amid an already tough regulatory atmosphere, she notes. “The instruments in play include not just the False Claims Act, but also general regulations under Medicare and Medicaid,” McIntee says. “In particular, the Recovery Audit Contractors program, which gives auditors bounties for recovering improper Medicaid and Medicare payments, continues to be one of the government’s most effective weapons.”

For his part, Hurd offers healthcare providers some frank advice on ways to improve their compliance programs. “The scope and scale of these changes are such that due diligence on payments and procedures needs to be comprehensive,” he says. “When you’re bringing in new employees, for example, take even greater care than usual not to ‘hire a problem.’ ”

Healthcare providers of all types and sizes should also update their compliance plans, working with in-house and outside legal counsel as appropriate, in response to the changes being wrought by ACA, Hurd adds. They should be cognizant of the rapid changes that are part and parcel of these regulations. “You have to watch for and respond to the new regulatory guidances that are emerging from federal agencies all the time,” Hurd advises.

And in general, healthcare providers should take particular care to properly account for any payments or procedures that might seem out-of-the-ordinary to outside observers or software. “Go ahead and do your own internal audits,” Hurd advises. “And as you do so, ask the question, ‘Why is this facility or this provider different, either in terms of revenue or types of procedures?’ Look for outliers, because that is exactly what the government is looking for. Be able to prove that those outliers have a logical explanation and are in full compliance with the law.”

The full webinar is available for download at

About LeClairRyan
As a trusted advisor, LeClairRyan provides business counsel and client representation in corporate law and litigation. In this role, the firm applies its knowledge, insight and skill to help clients achieve their business objectives while managing and minimizing their legal risks, difficulties and expenses. With offices in California, Connecticut, Massachusetts, Michigan, New Jersey, New York, Pennsylvania, Virginia and Washington, D.C., the firm has approximately 350 attorneys representing a wide variety of clients throughout the nation. For more information about LeClairRyan, visit


Press Contacts: At Parness & Associates Public Relations, Marty Gitlin (631) 765-8519, or Bill Parness, (732) 290-0121, parnespr(at)optonline(dot)net

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