Almost all healthcare providers face at some point having to disclose and refund potential overpayments to Medicare, Medicaid and other federal healthcare programs. Under the Affordable Care Act (“ACA”), a written disclosure and refund must occur within 60 days after an overpayment has been “identified.” Without interpretive regulations, providers are struggling nationwide with trying to understand and comply with the ACA’s requirements and the potential liabilities under the False Claims Act (“FCA”) for failure to comply. A recent federal decision in New York in Kane v. Healthfirst, Inc. et al., as well as the pending appeal before the US Supreme Court in the Universal Health Services case, have only added to the uncertainties. Join Sheppard Mullin partner Steven Chananie for an in-depth discussion of the law and the impact of the recent cases, and an exploration of practical strategies on how to navigate the ACA’s requirements.
I. Gain an understanding of the requirements and legal standards of the ACA and the FCA as to disclosing overpayments; the open issues under these laws; and the impact of the decision in Kane and the appeal in Universal Health Services
II. Learn practical strategies on how and when to conduct internal reviews of potential overpayments so as to minimize potential legal liability under the FCA (e.g., when a review must be done; how quickly it must be completed; how far back to go; how to select cases for review; how to quantify the overpayment, etc.)
III. Understand the relevant considerations regarding: (i) when and how to interact with the government, given the time limitations set forth in the ACA and the unsettled state of the law; (ii) which state or federal entities to contact; and (iii) what the potential liabilities and penalties might be under the FCA, even when a timely disclosure is made
Steven Chananie is a partner in the Corporate Practice Group in the firm's New York office, focusing on healthcare issues.
Areas of Practice
Mr. Chananie has represented numerous healthcare providers, advising them on regulatory and fraud and abuse issues in the structuring of complex healthcare transactions and arrangements; guiding them in the resolution of potential compliance problems; and assisting them in implementing or modifying their compliance programs. Mr. Chananie has also defended numerous clients against civil government actions and investigations, including in False Claims Act cases, threatened Anti-Kickback prosecutions, and various state and federal audits. He brings his knowledge of government enforcement efforts — along with his technical legal expertise and his practical understanding of how healthcare providers operate in the real world — to his guidance on regulatory and compliance matters.
His clients include academic medical centers, hospital systems, faculty practice plans, laboratories (both independent and hospital- based), physician practices, ambulatory surgery centers, nursing homes, and home health agencies.
Mr. Chananie has lectured nationwide on compliance, regulatory, defense and related issues.
Prior to entering private practice, Mr. Chananie was Chief of Appeals at the Queens County District Attorney’s Office (1993 - 1996), Counsel to Field Operations and chief appellate counsel at the New York State Organized Crime Task Force (1987 - 1993), and an Assistant District Attorney at the Manhattan District Attorney’s Office (1983 - 1987). While at the Manhattan District Attorney’s Office, he took a leave of absence to clerk for former Chief Judge Judith Kaye on the New York State Court of Appeals. Mr. Chananie has also taught Appellate Advocacy and Criminal Procedure as an adjunct professor at Brooklyn and Pace Law Schools.
The speaker brought me up to date. I am thankful.
Excellent and very important presentation. Well explained this complex subject matter.
instructor provide a lot of information on a very detail oriented subject
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