Trends in Fraud, Waste, and Abuse

[3047] Trends in Fraud, Waste, and Abuse

Education-Training Credits:

• 1.5 Hr(s) HCSSA Administrator/Alternate

Summary:Former Federal Prosecuters explain how your data helps determine fraud.

HCSSA Topic(s) Addressed:

• §558.259[d][4]agency responsibilities
• §558.260[a][6]risk assessment and management
• §558.260[a][7]financial management

Faculty: Mindy Sauter, JD and Mike Elliott, JD

Program Description: In order to curtail the continued presence of fraud, waste, and abuse within government programs, specifically home health and hospice, the OIG has implemented the use of data analytics to highlight providers who are outliers in terms of billing trends. It is essential that providers become aware of how their data analytics will be observed by an outside party. Along those same lines, emphasis is now being placed on provider-administered compliance programs. Successfully administered compliance programs will be key if a provider’s data analytics ever come into question. Use this presentation to gain insight from the original Federal prosecutors in the Dr. Roy case who successfully led the indictment for one of the largest fraud cases in home health.

Presentation Date: 08.09.2017

Learning Outcomes(s): Participants will actively engage in the learning activity and indicate an intent to change or enhance their practice by implementing compliance training and education within the agency’s operations.

About the Presenters:
Mindy Sauter, JD and Mike Elliott, JD are both former Assistant United States Attorneys who investigated and prosecuted health care fraud throughout the United States.

Mindy is a graduate of Oklahoma State University and SMU law school. Before she was a federal prosecutor, Mindy was an Assistant District Attorney in Dallas where she tried hundreds of cases and supervised felony prosecutions.

Mike is a graduate of the United States Naval Academy and the University of Miami School of Law. Prior to working in both the Southern and Northern Districts of Texas with the Department of Justice, Mike was in private practice in New York City. Their firm, Elliott Sauter, focuses on representing health care organizations and professionals in regulatory, compliance and criminal matters. Elliott Sauter is based out of Dallas, TX.

[3047] Trends in Fraud, Waste, and Abuse