Intent is a critical element examined in both civil and criminal healthcare fraud investigated by the government. To determine whether a provider’s actions were conducted with bad intent, federal and state prosecutors will review both traditional sources of data (medical records, billing records, etc.) and a wide variety of evidential sources during their investigation, including emails, voicemails, social media, instant messages, purchasing and charge card records, and any systems data or metadata from any electronic device.
Because e-mails, text messages, and social media posts can be easily misconstrued or misinterpreted, this can present problems for providers should they ever find themselves the subject of an administrative, civil, or criminal investigation.
Join Regina G. Morano, J.D., CHC, and Robert W. Liles, J.D., M.B.A., M.S., as they review the compliance risks inherent in the daily activities of doing business in a modern world, and what proactive steps providers need to take to stay ahead of risk.
Regina G. Morano, J.D., CHC, Chief Legal & Compliance Officer with National Spine and Pain Centers in Rockville, MD, began her healthcare career as a Jesuit Volunteer and founding staff member of Baltimore’s Health Care for the Homeless Program. She has served in key legal and compliance positions with physician, hospital, long-term care, laboratory, managed care and regulatory organizations, most recently as Chief Legal & Compliance Officer for University of Maryland Faculty Physicians Inc., and Senior Vice President of Compliance & Ethics for Ameritox, Ltd., a national clinical laboratory headquartered in Baltimore, Maryland. She also previously held the position of Vice President of Legal and Regulatory Affairs & General Counsel for URMC/ Thompson Health System in New York. Ms. Morano was nominated by her peers and awarded a Top Counsel Award by the New York Daily Record legal newspaper in 2011, and is a frequent presenter at national healthcare compliance and legal conferences.
Robert W. Liles, J.D., M.B.A., M.S., of Liles Parker, PLLC holds both an M.B.A. and M.S. in Health Care Administration, in addition to a law degree. Robert has worked on the provider side as a federal prosecutor and now represents health care providers around the country in Medicare / Medicaid / Private Payor audits, state board of licensure actions, and False Claims Act cases. He currently serves as an IRO on Corporate Integrity Agreements for the Office of Inspector General. While working as a federal prosecutor, Robert was asked to serve as the country’s first National Health Care Fraud Coordinator for the Executive Office for U.S. Attorneys, advising federal prosecutors around the country regarding health care fraud statutes, schemes, investigative tools, privacy concerns, and compliance issues. Since entering private practice, Robert has continued to build on his health care background and experience. Robert has been rated “AV” by Martindale-Hubbell.