Healthcare Fraud and Abuse – JURI 555

CG • Section • 12/17/2019 to 05/25/2020 • Modified 07/28/2020

Course Description

This course provides an understanding of the laws related to healthcare fraud and abuse in United States. The three major fraud and abuse statues – the False Claims Act, the Stark Law and the Anti-Kickback Statute – will be covered in detail. This includes identifying the statutory construction of each of these three statutes and seeing how different courts have applied them. Related subjects to be covered include, an overview of Federal and State agencies tasked with eliminating fraud and abuse in the healthcare arena, examples of settled and litigated cases and their impact on the healthcare industry and the history and ongoing evolution of healthcare fraud and abuse enforcement.

Prerequisites

None

Rationale

Federal and state healthcare laws have increased exponentially due to increased government healthcare expenditures. These laws often impose crippling monetary and criminal penalties on those engaged in delivering healthcare services, and thereby necessitate industry understanding of their scope and reach. Healthcare providers are presumed to know and understand these complex and ever-changing laws.

Measurable Learning Outcomes

Upon successful completion of this course, the student will be able to:

  1. Read and analyze legal materials including statutes, case law and case law interpretation, assimilating these teachings in order to articulate an understanding of the health care fraud and abuse laws in the United States.
  2. Demonstrate an understanding of the historical foundations of the health care fraud and abuse statutes in the United States, with emphasis on the biblical perspective and the premises on which the rules of law in this area of the law are based.
  3. Learn to identify legal issues in factual healthcare fraud and abuse-related scenarios, and then state and apply the principles and rules of law to these issues, arguing both sides of the issue and then deciding how a judge might rule on the issue.
  4. Understand the statutory construct of the False Claims Act (FCA) and read and understand cases argued in Federal Circuit Courts of Appeal and Supreme Court, looking for and understanding differing interpretations.
  5. Understand the statutory construct of the Stark Law and the Anti-Kickback Statute and appreciate how the business of healthcare in the United States is practiced under these statutes.
  6. Identify the factors that have led to enhanced enforcement of the fraud and abuse statutes and understand policies driving such enforcement.

Course Assignment

Textbook readings, case law, videos, and lecture presentations.

Course Requirements Checklist

After reading the Course Syllabus and Student Expectations, the student will complete the related checklist found in Module/Week 1.

Discussion Board Forums (4)

Discussion boards are collaborative learning experiences. Therefore, the student is required to create a thread in response to the provided prompt for each forum. Each thread must be at least 400 words, demonstrate course-related knowledge. And be supported by at least 2 scholarly citations in Bluebook format. In addition to the thread, the student is required to reply to 2 classmates’ threads. Each reply must be at least 200 words. (Outcomes: A, B, C, D, E. F).

Market v. Government Paper

The student will write a 1,200–1,500-word paper on the topic “What is a person and why does it matter?” The paper must contain at least 5 references in addition to the course textbook and the Bible. The paper must adhere to current Bluebook formatting. (Outcomes: A, B, C, D, E, F,)

Healthcare Fraud and Abuse Paper

The student will choose a topic in the field of healthcare fraud and abuse and write a research-based paper on the topic selected. This assignment is broken down into 3 parts:

Topic Proposal

The student will write a 750-word proposal for the Healthcare Fraud and Abuse Paper. The proposal will include the specific topic for the paper, thesis statement, and 10 preliminary scholarly sources from within the last 10 years. The proposal must adhere to current Bluebook formatting. (Outcomes: A, B, C, D, E, F)

Annotated Bibliography

The student will identify 10 scholarly sources relevant to the legal, moral, biblical, and ethical implications of the definition of personhood. The student must prepare an annotation of 150 words for each of the 10 sources. The sources here may be used for the Bioethics and Law Paper. This assignment must adhere to current Bluebook formatting. (Outcomes: A, B, C, D, E, F)

Final

Based on the topic outlined in the proposal and the feedback from the instructor, the student will write a 3,500–4,500-word research paper. The paper must include at least 20 scholarly references in addition to the course textbook and the Bible. This assignment must adhere to current Bluebook formatting. (Outcomes: A, B, C, D, E, F)