Medicaid Fraud and Abuse Enforcement on the Rise

Surviving Increased CMS and State Scrutiny

Recording of a 90-minute CLE webinar with Q&A

Conducted on Tuesday, March 11, 2008

Course Materials


Health care attorneys predict that preparing for heightened Medicaid compliance enforcement required by the Deficit Reduction Action of 2005 (DRA) will be one of the top compliance challenges for hospitals during 2008. The Medicaid program provides health coverage for 55 million Americans.

The DRA created a federal Medicaid integrity program, expanded funding for Medicaid fraud enforcement, and required that certain providers adopt new policies and educate their employees about avoiding Medicaid fraud.

Although the DRA compliance deadline was January 2007, confusion remains about what the new law requires, forcing providers to take an overly broad approach to ensure compliance. Failure to comply could result in numerous penalties, including exclusion from federal health care programs.

Listen as our panel of health care attorneys explains current initiatives and enforcement trends affecting Medicaid providers and offers best practices to ensure Medicaid compliance.



  1. Implementation of the Deficit Reduction Act (DRA)
    1. Employee education, policies and handbooks
    2. New incentives for state Medicaid programs
    3. Expanded enforcement and oversight
    4. Federal Medicaid Integrity Program
  2. Dynamic Activities by States and Federal Government
    1. Audits and Data Mining
    2. Costs Reports
    3. Quality of Care Initiatives
    4. Financial Incentives
  3. Managing New Operational Challenges
    1. Test Effectiveness of Your Compliance Program
    2. Stay Ahead of the Government
      1. Understand the Difference Between Fraud, Abuse and Improper Payments
      2. Theories of False Claims Violations Involving Quality and Regulatory Compliance
      3. Protect Yourself from Whistleblowers
    3. Improving Process and Systems: Proactive and Preventive Measures
      1. Internal Audits and Monitoring
      2. Effective Listening
      3. Communicating with the Government - Document and Production
      4. Retention Schedules
      5. Use of Counsel


The panel will review these and other key questions:

  • What measures are federal and state governments taking to identify and erradicate Medicaid fraud?
  • What are the best practices for hospitals to ensure compliance with the DRA and Medicaid program requirements?
  • What future changes can counsel expect as the government increases its focus on stamping out Medicaid fraud?


Paula G. Sanders
Paula G. Sanders

Post & Schell

She represents clients on Medicare and Medicaid survey and certification, compliance, and fraud and abuse issues. She...  |  Read More

Connie A. Raffa
Connie A. Raffa
Arent Fox

She has 28 years of experience in health care law, focusing on regulatory and reimbursement issues, corporate...  |  Read More

David Frank
David Frank
Director, Medicaid Integrity Group, Center for Medicaid and State Operations
Centers for Medicare & Medicaid Services

He is the Director of the Medicaid Integrity Group, which carries out the Medicaid Integrity Program. He was a state...  |  Read More