David Bocian and Peter KATZ
This course explores the issues of fraud and abuse in all aspects of health care programs,
and provides a background in federally funded programs like Medicare and Medicaid.
At the conclusion of this course, students should be familiar with (1) the False Claims Act 31 U.S.C. 3729, et seq., (2) the Anti-Kickback Act 41 U.S.C. 51, et seq., (3) the Medicare Medicaid Anti-Kickback Act 42 U.S.C. 1320a-7b(b), (4) the Stark Laws, (5) the mail, wire, and health care fraud statutes 18 U.S.C. 1341 et seq., (6) the fraud implications of violations of state law (fiduciary duty, commercial bribery, state licensing statutes).
The student should be able to apply these laws (and governing regulations) in the following contexts: (1) choosing and investigating cases (prosecution), (2) responding to investigations (defense), (3) identifying and preventing violations of these laws (compliance), (4) allocating risks of fraudulent or violative acts among parties (transactions), (5) representing a whistleblower.
This course will examine use of these statutes (and governing regulations) in the following health care contexts: (1) hospitals and health systems, (2) nursing homes and skilled nursing facilities, (3) health maintenance organizations and their subcontractors, (4) physicians and dentists, (5) pharmacists and pharmaceutical companies, (6) ancillary services (medical equipment, therapies, supplies), (7) laboratories, (8) mental health/substance abuse.