Attention:

CMS Data Mining and Other Trends in Health Care Enforcement


Level: Advanced
Runtime: 90 minutes
Recorded Date: May 02, 2018
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Agenda


  • OIG and Data Collection
  • Data Mining
  • OIG Data Analytics
  • Pharmacies: Patterns of Outliers
  • Home Health Agencies: Patterns of Outliers
  • Data Mining in Prosecuting Compounding Pharmacies and Physicians
  • Presenting a Defense
  • 2018 Enforcement Trends
  • Insys Therapeutics Prosecution
  • Key Takeaways
Runtime: 1 hour and 30 minutes
Recorded: May 2, 2018

Description

The panel will discuss CMS data mining and other health care fraud enforcement trends. Topics will include how the government uses the information to identify targets and indict, as well as how defendants can defend against the information.

This program was recorded on May 2nd, 2018.

Provided By

American Bar Association

Panelists

Carolyn Bell

Assistant U.S. Attorney
U.S. Department of Justice

Carolyn Bell is an Assistant U.S. Attorney in the West Palm Beach Office of the United States Attorney for the Southern District of Florida focusing on white-collar criminal prosecutions. In addition to her regular caseload, Ms. Bell has been the Professional Responsibility Officer for the Northern Region of the Southern District of Florida for almost 15 years. In this capacity, she acts as an in-house Ethics Counsel for Assistant U.S. Attorneys in South Florida. Ms. Bell is also involved in both state and local bar activities. She currently serves as the Chairman of the Florida Bar Professional Ethics Committee, and is the former Co-Chairman of the Professionalism Committee of the Palm Beach County Bar Association.

Prior to coming to the Southern District of Florida, Ms. Bell was a Senior Trial Attorney in the Tax Division, Criminal Section, of the U.S. Department of Justice, in Washington, D.C. Ms. Bell’s Washington service included assignments in the U.S. Attorney’s Office in the District of Columbia, and on the Deputy Attorney General’s staff. While in Washington, Ms. Bell also worked as an Adjunct Professor at George Washington University, School of Law. Ms. Bell began her career as a civil litigator at Buchalter, Nemer, Fields and Younger, a large commercial firm in Los Angeles, California. She received both her undergraduate and law degrees from the University of California, Berkeley.

Ms. Bell regularly lectures on a wide variety of topics relating to ethics and criminal prosecutions to Department of Justice attorneys, law enforcement agencies, state and local bar associations, and local universities and law schools. She has also authored articles for both governmental and private publications, and has received numerous awards and recognitions throughout her career.

Kevin Napper

Managing Member
The Law Offices of Kevin J. Napper P.A.

Kevin Napper maintains an active trial practice handling a wide array of civil and criminal legal matters in all state and federal courts. He has been recognized for over 12 consecutive years in Best Lawyers in America in White Collar Criminal Defense, “Bet the Company” Litigation, Complex Commercial Litigation and Personal Injury Defense. He was named “2017-2018 Lawyer of the Year” in Tampa in Qui Tam defense and was named “2016-2017 Lawyer of the Year” in Tampa in Mass Torts (Defense) and Class Action Defense. With over 33 years’ experience he has tried dozens of criminal and civil cases to jury verdict and has successfully handled hundreds more. Mr. Napper has extensive experience guiding individuals and corporations, large and small, public and private, through the treacherous waters of criminal and civil investigations and trials. Much of his work results in favorable resolutions before a case becomes public or goes to trial. He understands that clients entrust him with their assets, their lives and their integrity. He endeavors to provide the finest service and to obtain the best results for clients as quietly, discreetly and efficiently as possible.

Mr. Napper's services include the representation of C suite executives, business owners, healthcare executives (including physicians), CEOs, healthcare networks, hospitals and other entities in a broad array of civil and criminal matters. He represents individuals in state and federal grand jury investigations conducted by the United States Department of Justice, the United States Attorney’s Office and the Florida Attorney General’s office. Criminal enforcement has increased in recent years in the areas of Foreign Corrupt Practices Act (FCPA), Healthcare fraud, Securities and finance enforcement, Accounting fraud, Antitrust violations, Defense Contractor fraud, and Environmental regulation. Harsh penalties such as stiff fines and lengthy incarcerations are frequently sought for business executives. Effective representation in a criminal investigation or prosecution requires not only knowledge of the criminal statutes and rules, but also experience with the offices and agencies that enforce them.

Mr. Napper has significant successful experience with the governmental agencies which bring these investigations and prosecutions. Mr. Napper has extensive jury trial experience handling professional liability matters for healthcare providers including anesthesiologists, surgeons, radiologists, Internal medicine specialists and other medical specialties. He has represented hospitals and physicians in birth injury, failure to diagnose, surgical malpractice and other matters involving allegations of professional negligence. Mr. Napper has successfully defended at trial and in hearings, hospitals, physicians and other healthcare providers in medical malpractice litigation, licensing and medical staff disputes and other issues in the healthcare industry.

Marissel Descalzo

Partner
Tache, Bronis, Christianson and Descalzo, P.A.

Marissel Descalzo is a trial attorney and focuses her practice on complex criminal and civil litigation in both federal and state court. Ms. Descalzo has participated in numerous trials to verdict. Ms. Descalzo handles criminal and civil matters of vital importance to clients’ businesses or their personal lives. She represents individuals and organizations accused of fraud and/or deceptive practices, and assists and advises organizations on corporate governance and compliance matters, including in the area of anti-money laundering. Ms. Descalzo represents hospitals, skilled nursing facilities, pharmacies, and other health care providers, during government investigations and defends them in qui tam (whistle-blower) actions. Ms. Descalzo regularly counsels companies from a variety of industries on the adoption and operation of their compliance programs and, in particular, assists companies in the food and beverage industry with internal investigations and ethics issues.

Ms. Descalzo also represents victims of fraud in federal criminal proceedings during all stages of the criminal process. She has a unique service helping victims—whether businesses or individuals—present criminal cases to prosecutors. Most importantly, she represents victims during the sentencing and restitution proceedings in order to optimize the return of the victim’s funds.

Finally, she has significant experience working with companies in connection with data security and privacy issues. She leads teams responding to data breaches and works with companies and law enforcement investigating potential threats to patient privacy and security.

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