2020 Healthcare Enforcement Compliance Conference

Medical necessity cases are very much alive in the FCA world, though the environment is ever-changing. This panel, consisting of an attorney in DOJ’s Civil Division, a health system chief compliance officer, defense counsel and relator’s counsel will examine the evolving landscape

We will consider the primary legal issues involved in medical necessity cases, recent relevant court rulings, as well as the regulations typically in play in common questions of medical necessity

We will discuss when fraudulent conduct becomes criminal conduct in cases alleging medically unnecessary testing and/or procedures

Do robust compliance measures prevent medical necessity cases? Do aggressive defense tactics head them off? We will examine the effect of compliance and defense strategy on DOJ investigations of allegations of lack of medical necessity