The Accountable Care Act (health reform) included a broad range of new statutes to crack down on health care fraud and abuse by increasing enforcement and keeping offenders from participating in government health programs.

"The government's focus on fraud is here to stay, so it's important for people to try to navigate through the federal health care programs to stay current on all the changes," says Amy Nordeng, government affairs counsel at the Medical Group Management Association.

Nordeng and Robert Saner, principal at the Washington-based law firm Powers Pyles Sutter & Verville, will walk through the anti-fraud changes during an educational session at MGMA's Annual Conference, Oct. 24-27 in New Orleans.

The reform law includes changes to provider enrollment processes, a 60-day period to return self-identified overpayments, higher penalties, and elimination of hurdles to proving a provider's intent to defraud that may have been in place in certain jurisdictions. The quick return of overpayments, in particular, will require significant restructuring of multiple processes within provider organizations, Nordeng says.

She and Saner will review changes enacted and under consideration, identify new provisions of the Stark Act and additional provisions under consideration, and impress upon attendees the enforcement abilities and trends of the federal Office of Inspector General.

The session, "E4, Compliance in the New Era of Heightened Government Scrutiny," is scheduled at 1:45 p.m. on Tuesday, Oct. 26. More information is available at mgma.com.

--Joseph Goedert

 

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