Quality of Care Compliance Under Heightened Government Scrutiny: Best Practices for Hospitals to Protect Medicare Reimbursement and Avoid False Claims Act Liability

Foley Partner Cheryl Wagonhurst is speaking on a live 90-minute teleconference for Strafford Publications with Heather L. Fesko, Partner, McGuire Woods and John E. Steiner, Jr., Chief Compliance Officer, University of Kentucky Healthcare on February 12, 2009 from 1:00 p.m. – 2:30 p.m. ET.

Their presentation is titled “Quality of Care Compliance Under Heightened Government Scrutiny: Best Practices for Hospitals to Protect Medicare Reimbursement and Avoid False Claims Act Liability.”

This seminar will address the challenges hospitals face in overseeing quality of care compliance and offer strategies for complying with Medicare regulations and avoiding False Claims Act liability and government enforcement actions.

Quality of care compliance is a priority healthcare concern for the government. The Centers for Medicare and Medicaid Services (CMS) has linked Medicare reimbursement with quality of care compliance, and regulators are enforcing quality of care through the False Claims Act and other laws.

The heightened scrutiny of quality of care issues will require hospitals to closely monitor compliance, ensure the medical necessity of procedures, and exercise caution when certifying Medicare and Medicaid regulatory compliance in order to reduce liability exposure.

Listen as our panel of healthcare attorneys addresses the challenges hospitals face in overseeing quality of care compliance. The panel will offer its insights and strategies for healthcare providers to comply with federal regulations and avoid False Claims Act liability and government enforcement actions.

1. Quality of care — current trends
   
   
   
   1. Payment and reimbursement trends
      
   2. Recovery Audit Contractor (RAC) audits
      
   3. Hospital quality reporting data
      
   4. Civil and criminal prosecutions
   
   
2. Strategies to ensure compliance and avoiding government enforcement actions
   
   
   
   1. Conduct internal quality of care audits
      
   2. Develop proactive compliance strategy

The panel will review these and other key questions:

• What steps has the government taken to increase its enforcement of quality of care compliance?
  
• What is the relationship between quality of care compliance and Medicare reimbursement?
  
• What practices should hospitals adopt to avoid liability under the False Claims Act and other state and federal laws for quality of care missteps?