An In-house Counsel’s Guide to U.S. Administrative Enforcement Efforts Under the Affordable Care Act

Through its components, the U.S. Office of Inspector General (OIG) and the U.S. Centers for Medicare and Medicaid Services (CMS), the U.S. federal Department of Health and Human Services (HHS) is increasingly utilizing its administrative authorities to enforce its expectations with respect to the delivery of items and services covered by the federal healthcare programs. The U.S. Affordable Care Act provided HHS with a host of new and enhanced administrative enforcement tools, many of which have already been implemented. Administrative enforcement efforts differ from the more familiar investigations by the US Department of Justice (DOJ) in several key ways, including: 

• Administrative actions often get to a result more quickly than a DOJ investigation but can have a similarly devastating effect;


• The agency (OIG or CMS) writes the rules (usually in regulations, but some of it subregulatory);


• The agency may exercise broad discretion in dealing with similar issues (“equal punishment for equal acts” may not be a concern);


• Rules of evidence, issues that can be addressed, and the burden of persuasion differ by forum.


• The agency may pursue matters in which DOJ would have no interest.

This webcast will provide an overview of the most commonly used administrative enforcement authorities, with tips to avoid the traps for those unfamiliar with the landscape.

For more information and to register, please visit the ACC website.