Health Care Fraud and Abuse Update: Federal and State Rules and Trends 2025

Fending off fraud

Whether it’s over-billing for services rendered, billing for services not rendered, or filing claims for non-existent treatments, health care fraud can harm patients and increase the cost of care for all Americans. In response, the Department of Justice’s (DOJ) Health Care Fraud Unit has ramped up its enforcement activities. For example, one of the DOJ’s recent fraud enforcement initiatives charged 193 defendants—including 76 medical professionals—in schemes involving $2.75 billion in fraudulent claims targeting federal health care programs and private insurers.¹

Join Charles R. Roozen and Joseph N. Wolfe for Health Care Fraud and Abuse Update: Federal and State Rules and Trends for an overview of fraud and abuse laws, including recent regulatory updates reflecting the transition to value-based care.

Key topics include:

• The Anti-Kickback Statute (AKS): Recognize the criminal implications of exchanging remuneration for referrals and newly introduced safe harbors protecting value-base arrangements, patient engagement tools, and cybersecurity technology donations
• The Stark Law: Explore civil penalties for improper self-referrals by physicians, with an emphasis on updated exceptions for value-based care and more precise definitions to ease compliance burdens
• The Civil Monetary Penalties Law (CMPL): Understand the financial and administrative consequences of violations, including recent adjustments aimed at reducing the regulatory obstacles for telehealth technologies and supporting value-based care models
• Wisconsin-Specific Health Care Fraud Laws: Gain insights into Wisconsin statutes designed to prevent and penalize fraudulent and abusive practices within the State’s health care system

Discuss how the new “value-based enterprise” rules might encourage health care providers to adopt innovative models for care coordination and payment structures. You’ll also discuss fair market value issues, audits, self-disclosures, and related compliance strategies.

With help from Health Care Fraud and Abuse Update: Federal and State Rules and Trends, you can stay current on regulatory updates, mitigate risks, and ensure compliance in an evolving regulatory landscape.

¹ Justice.gov: National Health Care Fraud Enforcement Action Results in 193 Defendants Charged and Over $2.75 Billion in False Claims

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