OIG Operations and Compliance Considerations for the Healthcare Provider

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About Course

Format: Live Webinar
Presenter: Eric Rubenstein, MSCJ, CFE
Event Date: 06/27/2023
Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Duration: 60 minutes

Conference Materials (Password Required)

This presentation will discuss the investigative and operational considerations that are undertaken by the OIG as part of the lifecycle of a criminal, civil or administrative investigation. This will segue into the importance of data analytics and the need for a robust compliance program that relies upon external audits and reviews.

Learning Objective:

  • Attendees will understand OIG case origins
  • Attendees will learn the difference between proactive and reactive investigations
  • Attendees will be able to understand how OIG cases are initiated
  • Attendees will learn about the importance of data analytics in both identifying investigations and proactive compliance
  • Attendees will be able to identify key concepts needed to be implemented to ensure that a quality proactive compliance program is in place
  • Attendees will understand how to interact with law enforcement in various settings

Areas Covered in the Session

  • The landscape of the OIG
  • The investigative considerations the OIG takes
  • Data Analytics in the healthcare compliance setting
  • Investigative Considerations for Determining a prosecutorial path
  • Proactive compliance measures as it relates to internal billing/coding data
  • Setting a policy for law enforcement interaction
  • Identifying the importance of a robust compliance program that takes into consideration the 7-points model compliance guidance published by the OIG
  • Live Q&A Session

Suggested Attendees

  • Compliance Officers
  • C-Suite
  • Billers, coders and auditors
  • Healthcare CEOs, CFOs, COOs
  • Office Managers
  • Billing Staff
  • Physicians
  • Medical Auditors
  • Practice Managers
  • Auditors
  • In House Counsel
  • Billing Companies
  • Clinic Owners
  • Compliance Officers
  • Chief Quality Officers
  • Senior Internal Auditors
  • Directors of Compliance
  • Regulatory/Risk Officers
  • Government Employees
  • General Counsel
  • Compliance Attorneys

About the Presenter

Seasoned retired federal law enforcement officer (25 years), specializing in white-collar crime investigations as a Special Agent for HHS-OIG. Wide-ranging experience involving federal healthcare programs, with an emphasis on crimes involving the Medicare and Medicaid programs by healthcare providers, including physicians, pharmacies and healthcare entities. Demonstrated success in complex criminal investigative management and planning. Over $500 million in restitution, forfeiture, damages, penalties and fines to government programs and over 150 convictions and civil settlements involving healthcare fraud matters. Broad trial experience, including three criminal trials in fourteen months (9 trials in all, including the first Civil False Claims Act trial in the District of New Jersey involving a violation of Stark). 20 years of presentation and training facilitation experience and a feature presenter/trainer at local, regional and national training academies, conferences (such as the National Healthcare Fraud Association and the American Association of Professional Coders) and subject matter case analysis. Extensive mentoring and training of new agents. A conduit of information on internal and external policies and procedures for criminal, civil and administrative investigative matters.

A previous member of the IBM UCM project, providing Subject Matter Expertise on FWA matters as part of the Optimization Team servicing all UCM user groups (including UPICS, MEDIC and the greater UCM user community-law enforcement). A former Partner Liaison of the Trusted-Third Party for the Healthcare Fraud Prevention Partnership (HFPP) serving the membership of the HFPP and providing SME in the areas of FWA and investigative efforts to combat FWA in healthcare.

Assist/consult with law firms and providers on due diligence, statistical sampling, self-disclosures, subpoena response, and OIG compliance-related issues, trial and litigation support. Subject Matter Expert (SME) in a variety of healthcare FWA issues, and previously retained as such for litigation and report preparation purposes.

Brazilian Jiu-Jitsu black belt.

Course Content

You can access all the webinar materials after successful payment

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