Hlth Care Fraud & Abuse (LAW-719B-001)
James Cannatti, Nicholas Alarif
This course satisfies the Health Care Compliance Certificate. Attached is a DRAFT syllabus, which the instructors will update leading up to the start of the semester.
This course will cover the health care fraud and abuse laws and regulations relating to the prosecution and defense of alleged wrongdoing by health care providers and suppliers. The Course will provide a basic overview of the laws governing healthcare providers and suppliers, such as hospitals, physicians and physician practices, clinical laboratories, medical device and pharmaceutical manufacturers, and nursing homes.
This Course explores the implications of the federal and state Anti-Kickback Laws, the federal physician self-referral law (Stark), the federal civil monetary penalty and exclusion laws, the federal and state false claims acts, as well as traditional federal white collar criminal laws as applied to health care. Emphasis will be placed on the federal laws but state law issues will also be considered.
In addition, this Course will consider voluntary and mandatory fraud and abuse compliance as well as the complexities and challenges that arise in developing and maintaining an effective compliance program. Particular attention will be paid to the federal sentencing guidelines on corporate compliance programs and the OIG’s compliance program guidance.
Textbooks and Other Materials
The textbook information on this page was provided by the instructor. Students should use this information when considering purchases from the AU Campus Store or other vendors. Students may check to determine if books are currently available for purchase online.
There is one mandatory textbook for this Course-- Legal Issues in Health care Fraud and Abuse, Fifth Edition (ISBN 9780769881577). Additional required reading materials primarily consist of statutes, regulations, and case law, along with federal and state agency guidance, and other publicly available materials will be assigned. Other than the mandatory textbook, all such materials are available on-line or will be distributed in class. Some assigned readings or course materials are subject to change.
First Class Readings
- Read Legal Issues in Health Care Fraud and Abuse--Chapter 1—The Fraud Enforcers: Who are they and what do they do? Pgs.1-30
- Skim Brief Summaries of Medicare and Medicaid, available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2018.pdf..
- Skim summaries of HHS Agencies and Operating Divisions (CMS, FDA, OIG). Navigate to each agency page and read the About section and explore the websites, available at: http://www.hhs.gov/about/agencies/operating-divisions/index.html.
- Navigate through the COVID-19 waivers to get an idea of how HHS, and in particular, CMS, responded to ease burdens during the pandemic, available at: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers.
Use your MyAU username and password to access the syllabus in the following format(s):