Annual Meeting Wrap

Government Speakers Detail Hot Topics in Fraud and Abuse

The Department of Health and Human Services Office of Inspector General (OIG) will continue to release updated compliance program guidance (CPG) as part of its modernization initiative, attendees of AHLA’s annual meeting were told by Susan A. Edwards, Office of Inspector General, U.S. Department of Health and Human Services, who, along with Scot T. Hasselman, Reed Smith LLP, and Kelley Hauser, U.S. Department of Justice, spoke on Hot Topics in Fraud and Abuse.

According to Edwards, OIG plans to release a general CPG by the end of this year that will help providers develop and maintain an effective compliance program. OIG will then issue by the end of next year managed care and nursing facility CPGs, Edwards said.

The informative session also covered fraud issues related to the end of the COVID-19 public health emergency. Hauser, noting that fraud enforcement always lags behind implementation of new reimbursement, assured the audience that more enforcement actions would be coming. Hauser also said that given the sensitivity of the emergency funds, DOJ would likely look harder at use of the funds and will pursue enforcement actions even if the recovery is not a big dollar amount.

Edwards also mentioned the OIG final rule on information blocking that was released early on June 27 and noted that a separate rule that will apply to providers will list “disincentives” for information blocking.

Hauser reviewed recent fraud case law, such as the SuperValu case on scienter—if there’s evidence that a defendant is questioning the accuracy of certain statements or billing, you’re probably going to hear from DOJ.

The speakers also discussed the use of AI and questioned whether it could be used to create clinical notes. Hauser noted that the government is generally in favor of any technology that could improve accuracy and predicted that more widespread use of AI will likely lead to a certification process of some sort to ensure that such programs work as intended.

Each speaker then chose an emerging topic to discuss. Hauser picked parallel criminal and civil investigations, highlighting that such investigations are advantageous to the government and he has seen a steady increase in them during his tenure at DOJ.

Edwards talked about managed care oversight and its increasing importance amid explosive growth in managed care. And Hasselman highlighted the corporate practice of medicine doctrine and urged lawyers to be aware of it while structuring transactions.

Use of Mid-Levels to Support Inpatient Service Lines

Susan J. Banks (Dentons US LLP) and Alexander Eremia (Virginia Hospital Center)

The speakers discussed issues regarding advanced practice providers (APPs) that must be considered, including:

• Strong quality of care, patient satisfaction, efficiency, and economic arguments support hospital engagement of APPs to bolster patient care for the benefit of the patient and the hospital.
• Regulators have concluded that hospital-based APPs may provide “remuneration” to physicians in certain circumstances, potentially violating the Stark Law and/or Anti-Kickback Statute.
• Compliance risk is heightened in surgical service lines due to Global Surgical Package reimbursement.  Nevertheless, there are ways to mitigate fraud and abuse risk associated with hospital engagement of APPs, even in the surgical setting.

Artificial Intelligence Impact on Health Equity

Tienne L. Anderson (St. Jude Children’s Research Hospital, Inc.) and Roma Sharma (Crowell & Moring LLP)

The race is on to develop artificial intelligence-enabled tools and technology. In parallel, governments around the world are racing to regulate this space. The speakers shared that how governments regulate this space will impact health care consumers and potentially advance or harm efforts to achieve health equity in the US and around the world.

Golden State Attendees Met in the Golden City

Californian attendees met on the morning of the last day of the Annual Meeting to network and share breakfast. As this year’s Annual Meeting was in San Francisco, AHLA partnered with the California Society for Healthcare Attorneys to create a space for Californian attendees to build a collegial community as they engaged with other health law professionals in their native state.

We extend our appreciation to the California Society for Healthcare Attorneys for sponsoring this breakfast.

Save the Date

2024 In-House Counsel Program and Annual Meeting

June 23-26, 2024
Washington, DC