Balance billing and the waiver of copays and deductibles can lead to criminal and/ or civil government enforcement actions. The False Claims Act is one area of potential liability that providers should be aware of because it could also lead to being excluded from participation in government programs such as Medicare and Medicaid. Various cases and the November 2023 HHS OIG Compliance Guidance document will be highlighted.
Additionally, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021 and became effective on January 1, 2022, is critical for providers accepting private insurance. There have been recent developments regarding the independent resolution process (IDR) and some notable court cases over the past two years.
The purpose of the presentation is to provide a semblance of the current landscape and to provide practical suggestions for compliance programs to implement in order to reduce the likelihood of legal, financial, and reputational damages.
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Attendees:
Rachel V. Rose, JD, MBA successfully advises and represents clients on healthcare,cybersecurity, securities, and qui tam compliance, transactional, litigation, and governmentenforcement matters. Ms. Rose is also an Affiliated Member with the Baylor College ofMedicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics. She hasserved as a consultative expert and testifying expert, as well as being often quoted inpublications.In addition to being extensively published and a sought-after presenter and quoted expert, Ms.Rose holds an MBA with minors in...