AMERICAN HEALTH LAWYERS ASSOCIATION

2015-2016 Practice Group Planned Activities and Project Report

October 2015

Practice Group: Fraud and Abuse Chair: Laura Laemmle-Weidenfeld

Project Title / Project Coordinator(s) / Project Description / Start Date / Projected Completion Date / Actual Completion Date / Status /

Chair

/ Laura Laemmle-Weidenfeld / 12/18/15: Submit written Mid-Year Report to the Board of Directors
5/20/16: Submit written Annual Report to the Board of Directors / 7/1/15 / Ongoing
Membership / Heather O’Shea / Vice Chair leads PG efforts to recruit members, retain members, and develop new leadership. VC to serve as liaison between Practice Group and Membership Board Committee.
Membership Committee Lead Coordinators: TBD / 7/1/15 / 6/30/16 / Ongoing
Publications / Joseph Kahn / Vice Chair monitor publication projects, solicits authors, and develops new written products. VC to serve as liaison between Practice Group and Professional Resources Board Committee and to coordinate Member Briefings, AHLA Connections feature article and email alerts, etc.
Publications Committee Lead Coordinators: TBD / 7/1/15 / 6/30/16 / Ongoing
Educational Programs / Kevin Raphael / Vice Chair leads PG efforts to educate and train PG membership through webinars, roundtables, tutorials, and luncheons. VC to coordinate Mid-Year and Annual Meeting luncheons, webinars, and serve as a liaison between Practice Group and Program planning committee.
Educational Programs Committee Lead Coordinators: TBD / 7/1/15 / 6/30/16 / Ongoing
Research & Website / Gary Herschman / Vice Chair monitors practice corner and develops new web-based products. VC is responsible for monitoring and overseeing relevant PG sub-site of AHLA website; make suggestions for additional postings, web links, etc.
Research and Website Committee Lead Coordinators: TBD / 7/1/15 / 6/30/16 / Ongoing
Strategic Planning and Special Projects / Carol Poindexter / Vice Chair monitors operation of PG and plans new programs, projects, or task forces. VC is responsible for PG Scope and monitoring Special Projects and Affinity Groups throughout the year.
Strategic Activities Committee Lead Coordinators: TBD / 7/1/15 / 6/30/16 / Ongoing
Social Media Coordinator / Alex Krouse / Coordinates social media postings and post AHLA publications and events. / 7/1/15 / 6/30/16 / Ongoing
Discussion List (#1)
Compliance / Stephanie Johnson
Kate Stern
Sara Kay Wheeler / Regularly monitor the Health Compliance discussion list and post questions to stimulate activity. / 7/1/15 / 6/30/16 / Ongoing
Discussion List (#2)
Stark Law List / Bill Maruca / Regularly monitor the Stark Law discussion list and post questions to stimulate activity. / 7/1/15 / 6/30/16 / Ongoing

Meeting: Mid-Year

/ Sponsor a luncheon meeting at the Fraud and Compliance Forum (September 27-29, 2015) in Baltimore, MD. Description and faculty due to AHLA on August 4, 2015.
Date: Monday, September 28, 2015
Title:The States’ Perspective: Strategies and Current Priorities for Combatting Fraud, Abuse, and Waste
Speakers: Ronald Chillemi and Christina Showalter
Moderator: Kevin Raphael / 9/28/15 / 9/28/15 /

Done

Meeting: Annual

/ Sponsor a luncheon meeting at 2016 Annual Meeting in Denver, CO (June 27-June 29, 2016). Description and faculty due to AHLA on February 1, 2016.
Date: TBD
Title: TBD
Speakers: TBD
Member Briefing (#1) / Title: Analysis of Key Provisions Contained in the 2016 Medicare Physician Fee Schedule Proposed Rule
Authors: Nancy Gillette, Amy McCullough, Sarah Browning, Reesa Handelsman, and Jessica Forster
Editors: David Lewsi, Julie Kass, Rick Hindmand
Co-Sponsors: Physicians, AMC, Fraud, HIT, HHS, IHC, RAP PGs, FMV, PIC, PHS AGs, ACO and HCR TFs / 8/15 / 8/15 / 8/11/15 / Done
Executive Summary (#1) / Title: Fourth Circuit Affirms $237 Million Judgment Against Tuomey, Finding No Error in Jury's Conclusion That Physician Compensation Varied with Volume or Value of Referrals
Author: Jesse Witten
Editor: Thomas Beimer
Co-Sponsor: AMC, BLG, HCL, HHS, IHC, MSCPR, RAP, and Tax PGs and CH and PIC AGs / 7/15 / 7/15 / 7/8/15 /

Done

Executive Summary (#2) /

Topic: Final Sunshine Regulation

Co-sponsors: Fraud, LS, THAMC PGs and COIT AG
Executive Summary (#3) / Topic: Implementing CMS 60-Day Refund Rule (Contact RAP PG for possible coordinated briefing) / TBD
Newsletter (#1) / Publication of newsletter discussing and analyzing recent developments in relevant areas of health law. / 4/15 / Annual Meeting / 6/3/15 / Done
Webinar (#1) / Title: Telemedicine—Exploring Different Delivery Models and Their Regulatory Consequences, Part I: Telemedicine—Strong Business Models from Strong Business Leaders (Intermediate)
Speakers: Michael Bess, Nathaniel Lactman, Deborah Mulligan, and Sarah Sossong
Co-sponsors: HIT, Behavioral TF, Fraud, HCL, HHS, IHC, Labor, MSCPR, PPMC, Physicians, PALS, RAP, TH, and BLG PGs / 4/15 / 6/1/15 / 6/1/15 / Done
Webinar (#2) / Title: Telemedicine: Making the Business Case for Telemedicine—Exploring Different Delivery Models and their Regulatory Consequences, Part II: Telemedicine Payment and Reimbursement—Embracing Opportunities to Fuel Real Growth (Intermediate)
Speakers: Nathaniel Lactman, Kristi Henderson, and Justin Stone
Moderator: Ross Sallade
Co-sponsors: HIT, Behavioral TF, Fraud, HCL, HHS, IHC, Labor, MSCPR, PPMC, Physicians, PALS, RAP, TH, and BLG PGs / 4/15 / 6/9/15 / 6/9/15 / Done
Webinar (#3) / Title: We’ve Got You Covered (or Not)… A Deeper Dive into Cyber Liability Insurance for Health Care Providers (Fundamental)
Speakers: Bruce Doeg, Michael Kerns, Robert Parisi, Dina Ross
Co-sponsors: HIT, BLG, HHS, LS, Physicians, AMC PGs / 4/15 / 6/10/15 / 6/10/15 / Done
Webinar (#4) / Title: Telemedicine: Making the Business Case for Telemedicine—Exploring Different Delivery Models and Their Regulatory Consequences, Part III: Assuring Data Privacy and Security in Telemedicine, Here and Abroad (Intermediate)
Speakers: Kelley Evans, Patricia Markus, and Peter McLaughlin
Moderator: Nesrin Tift
Co-sponsors: HIT, Behavioral TF, Fraud, HCL, HHS, IHC, Labor, MSCPR, PPMC, Physicians, PALS, RAP, TH, and BLG PGs / 4/15 / 6/18/15 / 6/18/15 / Done
Webinar (#5) / Title: Telemedicine: Making the Business Case for Telemedicine—Exploring Different Delivery Models and their Regulatory Consequences, Part IV: How to Protect Against Fraud and Abuse While Promoting Telemedicine (Intermediate)
Speakers: Martin Durkin, Terrence Lewis, and Sarah Swank,
Co-sponsors: HIT, Behavioral TF, Fraud, HCL, HHS, IHC, Labor, MSCPR, PPMC, Physicians, PALS, RAP, TH, and BLG PGs / 4/15 / 6/23/15 / 6/23/15 / Done
Webinar (#6) /

Title: The New MSSP Final Rule: What’s Next for the Future of ACOs? (Intermediate)Speakers: Danielle Lloyd, David Morris, and Debra SilvermanCo-Sponsors: ACO TF

/ 6/15 / 7/31/15 / 7/31/15 / Done
Webinar (#7) / Title: Medicare Physician Fee Schedule 2016 Proposed Rule: Important Policy Issues to Consider Now (Intermediate)
Speakers: Karen Ferguson, Julie Kass, Daniel Shay
Moderator: Rick Hindmand
Co-Sponsors: Physicians and ACO TF / 7/15 / 8/31/15 / 8/31/15 / Done
Webinar (#8) /

Title: 2015 Legal and Regulatory Developments and Their Potential Impact on FMV in Health Care Transactions, Part I: Holy Mackerel, What is this MACRA? Big Changes You May Have Missed and What They May Mean for FMV and Commercial Reasonableness (Intermediate)Speakers: Andrea Ferrari, Christopher Kenny, and David SzaboCo-Sponsors: FMV AG, HHS, Fraud, IHC, Physician, RAP PGs

/ 9/15 / 9/23/15
Webinar (#9) / Title: Behavioral Health and ACOs—Challenges and Opportunities (Intermediate)
Speakers: Clifford Barnes, Alexander Blount, and Sree Chaguturu
Moderator: Daria Niewenhous
Co-Sponsors: ACO and BH TF / 7/15 / 9/24/15
Webinar (#10) / Title: ACOs: Compliance Risks and Practical Solutions (Intermediate)
Speakers: Robert Gerberry, John Kirsner, and Cynthia Reisz
Co-sponsors: ACO TF / 8/15 / 10/7/15
Webinar (#11) / Title: Advanced Compliance Education, Part I: Advanced Issues in Pharmaceutical Manufacturer Compliance Programs (Advanced)
Speakers: Richard Eschle, Saul Helman, and Anne Norris
Moderator: Amy Dow
Co-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs / 9/15 / 10/815
Webinar (#12) / Title: Advanced Compliance Education Webinar Series, Part II: Compliance for Long Term Care Facilities (Advanced)
Speakers: Lori Baker and David Bowling
Moderator: Brian Roark
Co-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs / 9/15 / 10/15/15
Webinar (#13) /

Title: 2015 Legal and Regulatory Developments and Their Potential Impact on FMV in Health Care Transactions, Part II: Latest Tuomey Decision and What it Means for the Lawyer/Valuator Relationship (Intermediate)Speakers: TBDCo-Sponsors: FMV AG, HHS, Fraud, IHC, Physician, RAP PGs

/ 9/15 / 10/23/15
Webinar (#14) / Title: Advanced Compliance Education Webinar Series, Part III: Compliance for Academic Medical Centers (Advanced)
Moderator: TBD
Co-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs / 9/15 / 11/10/15
Webinar (#15) /

Title: 2015 Legal and Regulatory Developments and Their Potential Impact on FMV in Health Care Transactions, Part III: 2016 PFS—How Might the Changes Affect FMV and Commercial Reasonableness (Intermediate)Speakers: TBDCo-Sponsors: FMV AG, HHS, Fraud, IHC, Physician, RAP PGs

/ 9/15 / 11/13/15
Webinar (#16) / Title: Advanced Compliance Education Webinar Series, Part IV: Compliance for Medical Device Manufacturers (Advanced)
Moderator: TBD
Co-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs / 9/15 / 11/30/15
Webinar (#17) /

Title: Advanced Compliance Education Webinar Series, Part V: Compliance for Clinical Laboratories (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 12/8/15
Webinar (#18) /

Title: 2015 Legal and Regulatory Developments and Their Potential Impact on FMV in Health Care Transactions, Part III: 2016 PFS—How Might the Changes Affect FMV and Commercial Reasonableness (Intermediate)Speakers: TBDCo-Sponsors: FMV AG, HHS, Fraud, IHC, Physician, RAP PGs

/ 9/15 / 12/11/15
Webinar (#19) /

Title: Advanced Compliance Education Webinar Series, Part VI: Compliance for Home Health and Hospice Companies (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 12/15/15
Webinar (#20) /

Title: Advanced Compliance Education Webinar Series, Part VII: Compliance for Hospitals and Health Systems (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 1/7/16
Webinar (#21) /

Title: Advanced Compliance Education Webinar Series, Part VIII: Compliance for Medicare Advantage Plans (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 1/14/16
Webinar (#22) /

Title: Advanced Compliance Education Webinar Series, Part IX: Compliance for Ambulatory Surgery Centers (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 1/21/16
Webinar (#23) /

Title: Advanced Compliance Education Webinar Series, Part X: Compliance for Physician Practices (Advanced)Speakers: TBDCo-Sponsors: Fraud, AMC, HHS, IHC, LS, PPMC, Physicans, PALS, and RAP PGs

/ 9/15 / 3/3/16
Webinar (#24) / Topic: FCPA update
Speaker: TBD
Moderator: TBD
Co-sponsors: TBD
/ TBD
Email Alerts / Email membership upon issuance of important issues.
See Exhibit A for a detailed list of email alerts issued by the PG (list also includes alerts generated by the Enforcement Subcommittee, and OIG Advisory Opinion summaries provided by the Advisory Opinion Panel). / 6/15 / 6/15 (9)
7/15 (3)
815 (3)
9/15 (5) / Ongoing
AHLA Connections Feature Article / Write a feature article for August 2015 issue of AHLA Connections. Article due to AHLA on June 1, 2015.
Title: Entering a New Era: Criminalizing Health Care Non-Compliance
Author: Gary Herschman, Jack Wenik, and Daniel Funakowski / 6/1/15 / 6/1/15 / Done
AHLA Connections Feature Article / Write a feature article for August 2016 issue of AHLA Connections. Article due to AHLA on June 1, 2016. Due FY17
Title: TBD
Author: TBD / 6/1/16
Laura Laemmle-Weidenfeld / Laura Laemmle-Weidenfeld / Schedule regular conference call with Chair, Vice Chairs, Liaison, Staff, and other interested parties. / 8/15
Calls are held on 1st Fri. of every month at 12:00 pm Eastern / 8/7/15
9/4/15
10/2/15
11/6/15
12/4/15
1/1/16
2/5/16
3/4/16
4/1/16
5/6/16
6/3/16 / 8/7/15
9/4/15
PG Scope
/
Leadership
/ Annually review Practice Group scope and discussion list description; recommend updates, if necessary. / 7/1/15 / 6/30/16
Membership Survey / Survey membership for suggested topics, projects, etc. for Practice Group and to solicit volunteers.
/ 9/15 / 9/7/15 / 9/8/15 / Done
Recruitment Campaign / Work on member recruitment campaign. / 7/1/15 / 6/30/16
Task Force (#1)
Accountable Care Organizations Task Force / Carol Poindexter
(Liaison to ACO Task Force) / Monitor and evaluate the implementing statutes, regulations, cases, and secondary materials concerning ACOs. A joint task force of all 16 PGs. / 7/1/15 / 6/30/16 / Ongoing
Affinity Group (#1)
Advisory Opinions / TBD / Responsible for drafting summaries of CMS and HHS OIG Advisory Opinions.
See Exhibit A for a detailed list of summaries and other related alerts. / 7/14 / Ongoing
Affinity Group (#2)
Fraud & Abuse Enforcement / TBD / Monitor fraud and abuse enforcement activities and report on important developments in a timely manner. Focuses on developments from government enforcement investigations and litigation by providing the membership with complaints, indictments, and other materials that often illustrate how matters are resolved or pursued.
See Exhibit A for a detailed list of related email alerts and other alerts. / 7/14 / Ongoing
Affinity Group (#3)
Voluntary Disclosure / TBD
/ Affinity Group addressing health care compliance and enforcement disclosure issues.
- Update and publish disclosure survey before Annual Meeting.
- Assess new disclosure authorities. / 7/14 / Ongoing
Affinity Group (#4)
Compliance / TBD / Produce member briefing on CMS 60-day rule expected to be published in the Fall 2011; monitor compliance issues; publish work product related to compliance developments and best practices. / 7/14 / Ongoing
Affinity Group (#5)
Legislative Reform Task Force / TBD / Draft White Paper on possible legislative reforms to develop uniform fraud and abuse laws / TBD / TBD / TBD
Special Project (#2)
Patricia T. Meador Leadership Award / 2015 Nominating Committee / Patricia T. Meador Leadership Award in tribute to Patricia Meador and years of her outstanding contributions and exemplary leadership.
The award will be presented annually to a Fraud and Abuse PG member who has demonstrated extraordinary commitment to the PG’s mission of education and mentoring on healthcare Fraud and Abuse issues.
The first award was presented to Robert G. Homchick at the Fraud and Abuse Practice Group Luncheon on October 5, 2009 (Fraud and Compliance Forum).
The second award was presented to Kevin G. McAnaney at the Fraud and Abuse Practice Group Luncheon on September 27, 2010 (Fraud and Compliance Forum).
The third award was presented to Vicki L. Robinson at the Fraud and Abuse Practice Group Luncheon on September 26, 2011 (Fraud and Compliance Forum).
The fourth award was presented to Kathleen McDermott at the Fraud and Abuse Practice Group Luncheon on October 1, 2012 (Fraud and Compliance Forum).
The fifth award was presented to S. Craig Holden at the Fraud and Abuse Practice Group Luncheon on September 30, 2013 (Fraud and Compliance Forum).
The sixth award was presented to Mark Bonanno at the Fraud and Abuse Practice Group Luncheon on October 6, 2014 (Fraud and Compliance Forum).
The seventh award was presented to Joan Daily at the Fraud and Abuse Practice Group Luncheon on September 28, 2015 (Fraud and Compliance Forum). / 7/15 / 9/28/15 for presentation of award / 9/28/15 / Done
Special Project (#3)
Discount Program / Work on developing discount programs for practice group members. / 7/14 / 6/15 / Ongoing
Special Project (#4)
Website Review / Heather O’Shea / Evaluate and make recommendations to Fraud PG leadership on re-formation of PG web pages. / 7/14 / 6/15 / Ongoing
Special Project (#5)
Toolkit Development / Research other Practice Group toolkits and make recommendations to Fraud PG Leadership on developing our own toolkits. / 7/14 / 6/15 / Ongoing
Special Project (#6)
Social Media / Monitor Twitter Committee and ensure postings to Twitter account are timely and relevant. / 7/14 / 6/15 / Ongoing
Special Project (#7)
Stark Law / Research and make recommendations to PG Leadership on development of Stark Law online resources for our members (e.g., Stark Law Practice Corner). / 7/14 / 6/15 / Ongoing
Special Project (#8)
Toolkit
/ Toolkit on Stark Self-Disclosure. / 7/13 / TBD

AHLA encourages all Practice Groups to collaborate, communicate, and cooperate with other Practice Groups.