(LAWI-4073) - 2 UNITS

This two-unit course surveys criminal, civil and administrative enforcement in the health care field by looking at current trends in health care fraud and enforcement. Some fraud schemes are obvious, such as health care businesses stealing social security numbers in order to bill for nonexistent services, and hospitals paying kickbacks for homeless Medicare and Medi-Cal patients. Some fraud schemes are not so obvious - marketing drugs for a purpose not approved by the FDA (off-label marketing), certain payment arrangements or financial incentives between different health care players, and violations of highly complex and technical regulatory laws. The course will begin with a short overview of the health care delivery and financing system, with a focus on the general payment models of health care and the vulnerabilities and common fraud patterns associated with these payment systems. We will examine the Civil False Claims Act, the Federal Anti-Kickback Statute, Stark, HIPAA, the Federal Food, Drug, and Cosmetic Act, and various criminal fraud statutes, as well as the remedies that each provides. Finally, the course will give students a practical understanding of what is involved in health care fraud investigations. Students will learn about the tools that criminal and civil prosecutors use in investigating health care cases. The course culminates with an in-class case study where teams of students represent different sides in a hypothetical health care fraud investigation.