The False Claims Act (FCA) is one of the most powerful tools used by the federal government to combat fraud, waste, and abuse in healthcare billing. The FCA imposes significant civil and criminal penalties for submitting false or fraudulent claims to federal healthcare programs such as Medicare, Medicaid, and TRICARE. Violations can lead to multi-million dollar settlements, exclusion from federal programs, and criminal prosecution.
This course provides an in-depth legal analysis of FCA compliance, risk management, whistleblower actions, and defense strategies. Students will gain expertise in understanding the complexities of FCA enforcement, implementing internal compliance programs, and effectively responding to government investigations.
Course Objectives
By the end of this course, students will:
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Understand the Legal and Regulatory Framework of the False Claims Act (FCA) – Analyze statutory requirements, enforcement trends, and key legal definitions.
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Examine Common FCA Violations in Healthcare Billing – Learn how upcoding, unbundling, medical necessity fraud, and billing for non-rendered services create legal risks.
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Evaluate the Role of Qui Tam Whistleblowers and Government Investigations – Study whistleblower protections, qui tam lawsuits, and DOJ enforcement actions.
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Analyze Case Law on False Claims Act Settlements and Legal Precedents – Review high-profile healthcare fraud cases and their impact on FCA compliance.
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Assess Strategies for Responding to FCA Investigations and Subpoenas – Learn how to handle civil investigative demands, subpoenas, and government audits.
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Identify Best Practices for Internal Compliance Programs to Prevent FCA Violations – Develop risk mitigation policies, audit procedures, and employee training programs.
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Explore the Intersection of the FCA with Other Healthcare Fraud Laws – Investigate how the FCA interacts with the Anti-Kickback Statute (AKS) and Stark Law.
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Prepare for Future Trends and Legislative Changes Affecting FCA Enforcement – Examine evolving regulatory priorities, AI-driven fraud detection, and compliance challenges.
