One Purpose Test, Waiving Copays, FCA Learning Points, and Compliance Effectiveness Episodes
Check out the latest episodes on the Stark Integrity podcast hosted by Nelson Mullins Riley & Scarborough LLP's Nashville partner Bob Wade, featuring professionals in the healthcare industry.
One Purpose Test: Greber vs. Holland; A discussion with Gabe Imperato of Nelson Mullins
Unfortunate statements and emails can trigger a long and expensive journey for an organization. In this episode, Wade discusses the Greber and Holland cases as they relate to the One Purpose test with Gabe Imperato, longtime friend and partner at Nelson Mullins. Hear why the U.S. v. Holland case is a significant decision, how the court looked for evidence of willful conduct, why the decision exposes the shortcomings of the One Purpose Test, when it’s optimal for the government to apply the One Purpose Test, and why educating your organization on these matters is so important.
Waiving Copays: Legal or Illegal?
Waiving copays and deductibles has to be performed in a specific manner. In this episode, Wade details the ins and outs of waiving copays. Hear why the routine waiver of copays and deductibles can be illegal, you can waive them in certain instances, what will cause a claim to be overstated, what exactly a copay waiver is, and examples from recent cases.
DOJ 2022 False Claims Act Settlements and Judgments: Learning Points
There’s an interesting issue with respect to the amount of collection in 2022. In this episode, Wade highlights learning points from the DOJ (Department of Justice) 2022 False Claims Act (FCA) Settlements and Judgments. Hear why the qui tam bar still represents the largest dollar amount of settlements, individual accountability is still occurring, why we are still seeing classic fraud and abuse issues, the most notable cases and issues, and how the 2022 numbers compare to previous years.
Compliance Effectiveness: It Is about the Culture of the Organization
One of the most effective parts of a compliance program is to have a compliant culture. In this episode, Wade breaks down how to foster a culture of compliance. Hear why an ethical culture starts at the top, how to understand the culture of an organization, what to do if you believe your organization is making unethical decisions, how to measure the effectiveness of your compliance program, and the infamous examples of Enron and FTX.
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