Balance billing and the waiver of copays and deductibles can lead to criminal and/ or civil government enforcement actions. The False Claims Act is one area of potential liability that providers should be aware of because it could also lead to being excluded from participation in government programs such as Medicare and Medicaid. Various cases and the November 2023 HHS OIG Compliance Guidance document will be highlighted.
Additionally, the No Surprises Act, which Congress passed as part of the Consolidated Appropriations Act of 2021 and became effective on January 1, 2022, is critical for providers accepting private insurance. There have been recent developments regarding the independent resolution process (IDR) and some notable court cases over the past two years.
The purpose of the presentation is to provide a semblance of the current landscape and to provide practical suggestions for compliance programs to implement in order to reduce the likelihood of legal, financial, and reputational damages.
Learning Objectives
Areas Covered in the Session
Suggested Attendees
Rachel V. Rose, JD, MBA successfully advises and represents clients on healthcare,cybersecurity, securities, and qui tam compliance, transactional, litigation, and governmentenforcement matters. Ms. Rose is also an Affiliated Member with the Baylor College ofMedicine’s Center for Medical Ethics and Health Policy, where she teaches bioethics. She hasserved as a consultative expert and testifying expert, as well as being often quoted inpublications.In addition to being extensively published and a sought-after presenter and quoted expert, Ms.Rose holds an MBA with minors in healthcare and entrepreneurship from Vanderbilt University,and a law degree from Stetson University College of Law, where she graduated with varioushonors, including the National Scribes Award. Ms. Rose also attained a Certificate inNegotiation and Leadership from Harvard University.Ms. Rose is licensed in Texas and is a Fellow of the Federal Bar Association. Currently, sheserves as a Director on the FBA's National Board, is a Member of and the Immediate Past Chairof the Federal Bar Association’s Government Relations Committee, an Advisory Board memberof the Federal Bar Association’s Qui Tam Section, the co-editor of the American Health LawyersAssociation’s Enterprise Risk Management Handbook for Healthcare Entities (2nd Edition), aswell as a co-author of the ABA’s books The ABCs of ACOs and What Are International HIPAAConsiderations? She is extensively published and presents on a variety of matters related to herpractice. She has been named consecutively to the Texas Bar College, the National Women Trial LawyersAssociation’s Top 25, Houstonia Magazine’s Top Lawyers (healthcare), the National TrialLawyers Association’s Top 100 and The Nation’s Top One Percent. Ms. Rose was awarded1 st Healthcare Compliance’s 2019 and 2022 Top Presenter Award. In 2023, she was selected forSuperLawyers (healthcare).
