Fraud and Abuse Trends: Critical Issues for Health Plans

As enforcement tightens, how can you protect your organization? Learn the answer at a new Manatt webinar. 

In FY 2018, the federal government won or negotiated more than $2.3 billion in healthcare fraud judgments and settlements. During that same period, investigations conducted by the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) resulted in 679 criminal actions against entities or individuals engaged in crimes related to Medicare and Medicaid; 795 civil actions (including false claims lawsuits and civil monetary penalties); and 2,712 entities and individuals being excluded from Medicare, Medicaid and other federal healthcare programs.1

Clearly, the healthcare industry is enduring greater levels of scrutiny—with increasingly aggressive techniques, such as wiretaps, predictive modeling and video surveillance, making the healthcare landscape more perilous to navigate each year. Adding to the challenges for health plans is the growing popularity of Medicare Advantage plans, which can bring new potential for fraud. How can health plans respond to protect their organizations in this increasingly stringent enforcement environment? Find out in a new Manatt webinar. Click here to register free—and earn CLE. Key topics include:

  • Recent enforcement trends around Medicare Advantage plans and other issues key to health insurers
  • The criminal and civil statutes applicable to Medicare Advantage under which plans could be charged
  • Best practices for legal and compliance teams to follow in overseeing risk adjustment activities, including a review of downstream provider arrangements and a plan’s own risk adjustment initiatives
  • Emerging trends in the HHS-OIG’s work plan for oversight of Medicare and Medicaid managed care plans, including inappropriate denial of services and oversight of federal payments to managed care plans
  • Implications under the Anti-Kickback Statute and Civil Monetary Penalty Law for health plan marketing activities and insurance producer compensation
  • Traps for the wary (and unwary!) in wellness program incentives and value-based insurance design
  • Guidance on building effective compliance programs that protect your organization in today’s complex and aggressive enforcement environment



Michael Kolber, Partner, Manatt Health
Jacqueline Wolff, Partner, Investigations and White Collar Defense

1The Department of Health and Human Services and the Department of Justice Healthcare Fraud and Abuse Control Program Annual Report for Fiscal Year 2018, May 2019

Date and Time
Thursday, October 17

This program has been approved for 1.0 CA General MCLE credit, 1.0 NY CLE Professional Practice credit (transitional and non-transitional).

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This program does not constitute legal advice, nor does it establish an attorney-client relationship. Views expressed by presenters are strictly their own and should not be construed to be the views of Manatt or attributed to Manatt.



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