Course Description

601:578. HEALTHCARE FRAUD AND ABUSE LAW (3) WI (effective Fall 2016)


LE = 12

Health care fraud and abuse is one of the most important problems in our health care system and perhaps the largest area of health law practice. When one accounts for the amount of fraud and the resources devoted to prosecution, defense and prevention, health care fraud involves literally hundreds of billions of dollars. Additionally, health care fraud encompasses a vast array of entities engaged in the health care sector, including, among others, hospitals, physicians and physician group practices, HMOs, medical device and pharmaceutical manufacturers, medical researchers, clinical laboratories and nursing homes. This course will examine the most important of the numerous laws used in prosecuting criminal and civil actions against fraudsters, including the False Claims Act, the Anti-Kickback Statute and the Stark Law. The course will also examine the increasingly important areas of voluntary and mandatory compliance. As a writing intensive course, much of this learning will occur in the context of particular practice exercises, such as (but not all of!) the following: drafting a gain-sharing agreement between a hospital and its orthopedic surgical group; interviewing a client (or a potential witness) in deciding whether to bring a civil action under the False Claims Act; giving advice to a doctor-client who has drafted an agreement to be a medical director and his or her draft is rife with illegal provisions; drafting an agreement between medical researchers and a pharmaceutical or device company; responding to a compliance agreement proposed by a prosecutorial authority; writing a memorandum about whether the United States Department of Justice should intervene in a whistleblower suit; and explaining to a Board of Directors why self-disclosure of an actual instance of fraud is necessary.

Last updated April 29, 2016.