Health Care

Pamela Coyle Brecht to present at Federal Bar Association’s 2022 Qui Tam Conference

2022/02/24

On Thursday, February 24, 2022 Pietragallo partner Pamela Coyle Brecht will be presenting on “Private Equity – The Newest Face at the FCA Table” at the Federal Bar Association’s 2022 Qui Tam Conference. This annual event provides timely perspectives from all sides of the FCA ecosystem: prosecutors, relator-side attorneys, defense counsel, inspectors general, federal judges, and in-house counsel. For more information and to register, visit: https://www.fedbar.org/event/quitam22/ Read More

Pamela Coyle Brecht to present at Marcum Corporate Compliance & Fraud Summit

2021/10/07

On October 7th, Pietragallo partner Pamela Coyle Brecht will be a panelist at the Marcum Corporate Compliance & Fraud Summit. Pam, and her co-panelist David Glusman, Partner at Marcum LLP will be discussing Forensic Accounting in Healthcare. During our session, you’ll be introduced to anti-kickback and fraud and abuse issues in healthcare. Join us for this two-day virtual webinar and register here, https://lnkd.in/deYRtj3C Read More

Pamela Coyle Brecht to present at Pennsylvania Bar Institute’s A Day on Health Law 2021

2021/10/28

On Thursday, October 28, 2021, Pietragallo partner Pamela Coyle Brecht will present a “False Claims Act Update” at Pennsylvania Bar Institute’s A Day on Health Law webinar. A Day on Health Law is a one-day, six-hour spin-off of PBI’s annual Health Law Institute. The Health Law Institute brings health law professionals comprehensive updates, insights and practical advice and the opportunity to tailor your own personalized agenda through numerous breakout session options in addition to the complete sessions. To join Pam and an outstanding roster of healthcare professionals visit: https://lnkd.in/gfRu_EwJ Read More

Pamela Coyle Brecht to present at Health Care Compliance Association’s 2022 Managed Care Compliance Conference

2022/01/31

On Monday, January 31, 2022, Pietragallo partner Pamela Coyle Brecht will be presenting on “The Dos and Don’ts of Medicare Advantage and Medicaid Managed Care: Lessons from Recent Enforcement Activity” at the HCCA’s Managed Care Compliance Conference. This is an annual event for individuals who manage compliance at health plan providers. Learn the latest practices, share strategies, and connect with peers and mentors who face similar challenges. For more information and to register, visit: https://lnkd.in/gyjX4U7X Read More

The differences and similarities between American and Italian healthcare fraud, waste, and abuse laws: Part 3

2022/01/03

Part 1 of this article series, published in the November 2021 issue of Compliance Today, outlined in general the American and Italian healthcare systems. Part 2, published in the December 2021 issue, outlined America’s primary healthcare fraud laws. Part 3 of this series outlines the Italian healthcare enforcement regime, criminal law, and the Anti-Corruption Act. Italian enforcement against fraud and corruption, including in the healthcare field, has traditionally been reserved to criminal courts, with no specific effort to coordinate or combine these actions through civil remedies. In light of the largely state-funded healthcare system in Italy, government corruption is in the foreground of efforts to detect and prevent fraud, waste, and abuse in healthcare. Egregious scandals erupted in Italian healthcare sectors, especially in the 1990s. Perhaps the most notorious case involved Dr. Duilio Poggiolini, the Ministry of Health’s general manager of the pharmaceutical department whose fortune included gold, jewels, and paintings of enormous value.[1] Poggiolini was charged and arrested for using his position for personal benefit, and his sentence of seven and a half years in prison was reduced on appeal.[2] The scandal surfaced during an investigation, called “mani pulite,” by a pool of public prosecutors operating out of the Milan criminal court. They were able to pierce the veil of silence that long protected government corruption. While its success resulted from significant cooperation and solidarity among the prosecutors, their coordination was not officially structured as an institutional team. Italy’s criminal law Italian criminal law always has included crimes of government corruption. The Italian Criminal Code has been amended periodically, not only to increase the sanctions (as, for example, in the latest “Spazza-Corrotti” amendments in 2019), but also with the aim of criminalizing more subtle corruption than an outright offer of cash in exchange for favorable treatment by a public official. Read More

In Post-Pandemic Era, What Will Return to Office Look Like?

2021/12/20

Pietragallo attorney Kevin E. Raphael was featured in a recent Pennsylvania Bar News feature on “In Post-Pandemic Era, What Will Return to Office Look Like?” Mr. Raphael first spoke on the topic on the “Business and Practice of Law Post-COVID: How will it Change?” webinar conference for the Pennsylvania Bar Association’s Large Law Firm Committee in mid-November. Interested in reading the piece? You can find it here: https://www.pabar.org/members/barnews/2021/BarNews_1216.pdf Read More

The differences and similarities between American and Italian healthcare fraud, waste, and abuse laws: Part 2

2021/12/01

Part 1 of this article series, published in the November 2021 issue of Compliance Today, outlined in general the American and Italian healthcare systems. Part 2 outlines America’s primary healthcare fraud laws. Part 3 of this series, to be published in the January 2022 issue of Compliance Today, will outline Italy’s fraud and abuse laws. In America, the enforcement landscape is ever evolving. Compliance within this thicket of criminal, civil, and administrative laws and regulations can prove especially challenging. The most used fraud and abuse prevention tools include the federal Anti-Kickback Statute (AKS), the federal False Claims Act (FCA), state false claims acts (FCAs), Stark Law, and more recently the Physician Payments Sunshine Act. In addition to these laws, there are two important industry codes of conduct that govern behavior: the PhRMA Code on Interactions with Health Care Professionals, which covers the pharmaceutical industry, and the AdvaMed Code of Ethics, which covers the medical device industry. Anti-Kickback Statute and its growing exceptions The AKS is a powerful federal law that seeks to prevent financial considerations from interfering with the independent medical judgment and purchasing decisions of healthcare providers.[1] In general, this law prohibits a company or individual from offering a healthcare provider, such as a doctor or hospital, incentives (referred to as “inducements”) to encourage use of its products or services.More specifically, the AKS imposes criminal penalties on any person who knowingly and willfully solicits, receives, offers, or pays any “remuneration” (including any kickback, bribe, or rebate) directly or indirectly, in cash or in kind, to any person to induce that person to either: refer an individual to a person for the furnishing of an item or service for which payment may be made in whole or in part under a federal healthcare program, or purchase, lease, order, or arrange for or recommend the purchasing, leasing, or ordering of any good, facility service, or item for which payment may be made in whole or in part under a federal healthcare program. Read More

Michael Morse to present at Health Care Compliance Association’s Healthcare Enforcement Compliance Conference

2021/11/10

On Wednesday, November 10, Pietragallo partner Michael Morse will present on Laboratory Enforcement and Compliance at the 2021 HCCA Healthcare Enforcement Compliance Conference. His panel will review recent case studies with a discussion of what those cases tell us about risks related to medical necessity and arrangements, discuss practical solutions and best practices for mitigating risk, and give updates on the Eliminating Kickbacks in Recovery Act. To register, visit here https://www.hcca-info.org/conferences/national/2021-healthcare-enforcement-compliance-conference. Read More

“Investigations”, Medicare and Medicaid Fraud and Abuse, 2021 ed.

2021/10/25

Pietragallo attorneys Kevin E. Raphael, James W. Kraus, and Daniel P. Wotherspoon revised Chapter 6 “Investigations” in the Medicare and Medicaid Fraud and Abuse, 2021 ed. of Thomson Reuters’ Health Law Series. Mr. Raphael has reviewed and updated this chapter annually for the past fifteen years. Medicare and Medicaid Fraud and Abuse introduces fundamental concepts as well as detailed analysis of the aspects of Medicare and Medicaid fraud and abuse, including regulation, caselaw, advisory opinions, and more. Their chapter discusses all aspects of government investigations in healthcare, including: the key players; challenges to subpoenas; defenses; and practical advice for managing and responding to government investigations. Interested in reading a chapter? You can find the book here: https://store.legal.thomsonreuters.com/law-products/Treatises/Medicare-and-Medicaid-Fraud-and-Abuse-2021-ed-Health-Law-Series/p/106737488. Read More

The differences and similarities between American and Italian healthcare fraud, waste, and abuse laws: Part 1

2021/11/01

This is Part 1 of a three-part series discussing the similarities and differences between the US and Italian healthcare fraud, waste, and abuse laws. Part 2 of this series will be published in the December issue of Compliance Today, and Part 3 will be published in January 2022 issue of the magazine. The United States of America and the Italian Republic share many common ideals. America was named after Amerigo Vespucci, an Italian explorer.[1] The American Constitution is based on the principle of government “of the people, by the people, for the people.” The Italian Constitution embodies this same principle in the ideals of sovereignty to the people: “La sovranità appartiene al popolo.” As of 2003, almost 16 million Americans claimed to have had Italian heritage.[2] With shared values, our two countries have forged an indelible alliance. These allied nations work together as world leaders in responding to a wide variety of economic, political, medical, technological, and scientific challenges that confront a rapidly changing world. A major challenge confronting both America and Italy is providing a healthcare system that extends medical treatment that is effective, innovative, devoid of fraud, and cost efficient. While the healthcare systems in America and Italy differ in many respects, they suffer from the same obstacles: fraud, waste, and abuse. Both countries take these problems seriously. For example, in America, the federal government recovered more than $2.2 billion in 2020 alone from healthcare fraud and false claims,[3] while in Italy the National Anti-Corruption Authority (Autorità Nazionale Anticorruzione) is actively monitoring, preventing, and responding to corruption, as well as issuing anti-corruption plans. This article highlights laws enacted in America and Italy to combat fraud, waste, and abuse, showing important similarities as well as differences between these enforcement efforts. Given the close historical and commercial ties between America and Italy, including healthcare companies that regularly operate in both countries, all stakeholders involved in healthcare (i.e., Read More

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Upcoming Events

Pamela Coyle Brecht to present at Health Care Compliance Association’s 2022 Managed Care Compliance Conference
January 31, 2022
On Monday, January 31, 2022, Pietragallo partner Pamela Coyle Brecht will be presenting on “The Dos and Don’ts of Medicare Advantage and Medicaid Managed Care: Lessons from Recent Enforcement Activity” at the HCCA’s Managed Care Compliance Conference. Read More
Pamela Coyle Brecht to present at Federal Bar Association’s 2022 Qui Tam Conference
February 24, 2022
On Thursday, February 24, 2022 Pietragallo partner Pamela Coyle Brecht will be presenting on “Private Equity – The Newest Face at the FCA Table” at the Federal Bar Association’s 2022 Qui Tam Conference. Read More
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