1. John T. Brennan, Jr. Crowell & Moring LLP Robert Homchick Davis Wright Tremaine LLP Vicki L. Robinson Chief, Industry Guidance Branch Office of Inspector General U.S. Department of Health and Human Services Fraud and Abuse in Health Care Reform: Will You Know It When They See It?

2. Disclaimer Nothing in this presentation reflects the position (official or unofficial) of Office of the Inspector General of HHS, Davis Wright Tremaine, or Crowell & Moring This presentation is based on the personal observations and opinions of the speakers Typical Lawyer blah, blah, blah

3. Key Themes More Rigorous Gatekeeping Stronger Health Care Fraud Statutes and Penalties Enhanced Investigative Tools for Government Transparency and Compliance New Fraud and Abuse Risks (Quality, Public/Private Intersect, New Payment Models)

4. More Rigorous Gatekeeping Provider screening What will it take to get a provider number? Expanded oversight of new providers Providers in the cross-hairs – DME, home health, SNFs

5. Stronger Health Care Fraud Statutes and Penalties Anti-kickback Statute amendments Stark Law amendments a nd self-disclosure False Claims Act amendments What isn’t a claim? What’s left of the public disclosure bar? Repayment obligations and FCA implications New administrative penalties (CMPs/exclusions) New money for enforcement and prevention

6. Enhanced Investigative Tools for Government New access to information from providers New subpoena authorities Payment suspension

7. Transparency and Compliance Mandatory compliance plans Sunshine Act and related transparency/disclosure provisions

8. New Fraud and Abuse Risks Quality as a risk area (i.e., increased linkage of quality to payment) New Federally funded programs/private sector intersections with Federal dollars

9. New Fraud and Abuse Risks (cont) Implications for new payment and delivery models (ACOs/medical homes/bundled payments) New fraud risks – e.g., cherry picking, lemon dropping, stinting Is there sufficient flexibility under the existing fraud and abuse laws? Waiver provisions in CMS demos Challenges moving forward