MEDICAL NECESSITY: FRAUD, FALSE CLAIMS AND MANAGED CARE

Friday, April 3, 1998
Leading experts from private practice, academia, government and the provider and payer communities speak on a variety of topics of great importance to the way managed care is delivered and regulated in the United States with particular emphasis on cost containment mechanisms derived from fraud and false claims actions.

Publication of Proceedings
Participants will publish articles in the Health Law Symposium Issue of the Saint Louis University Law Journal.

Speakers

Timothy S. Jost
The American Difference in Health Costs: Is There a Problem? Is Medical Necessity the Solution?
Professor Jost is Newton D. Baker Professor of Law and Processor of Health Services Management at Ohio State University School of Law. He is co-author of Health Law, a treatise and casebook on health law published by West Publishing and is author of The Law of Medicare and Medicaid Fraud and Abuse recently published by West Publishing.

Timothy P. Blanchard
Medicare Determinations Regarding Reasonableness and Necessity: Abuses of Discretion and Process in the Pursuit of Fraud and Abuse
Mr. Blanchard is a member of McDermott, Will & Emery, Los Angeles, California. His areas of practice include Medicare and Medicaid billing and payment, managed care regulation, provider certification and licensing, utilization review, corporate compliance programs, and fraud and abuse audits and investigations. Mr. Blanchard is chairman of the Regulation, Accreditation and Payment Substantive Law Committee of the NHLA/AAHA, Inc., and is certified as a Healthcare Financial Professional (CHFP) by the Healthcare Financial Management Association.

John R. Munich
When Neglect Becomes Fraud: Quality of Care and False Claims
Mr. Munich is Deputy Attorney General for Litigation, Office of the Attorney General of Missouri. He formerly served as an Assistant United States Attorney in Washington, D.C., and prosecuted false claims cases involving the health care industry.

Geraldine Nicholson
Medicare Contractor Review of Claims: Environment and Process
Ms. Nicholson is Director of the Division of Methods and Strategy, Office of Financial Management, Program Integrity Group, Health Care Financing Administration at HHS. She supervises long range planning for program integrity matters and has been involved in matters concerning fraud and abuse.

Lena Robins
Payment Suspension
Ms Robins is an attorney with the U.S. Department of Health and Human Services, Office of the General Counsel--Health Care Financing Division. She advises HCFA and the General Counsel of HHS in matters involving regulations, manual issuances and statutory matters concerning fraud and abuse pertaining to M & M programs.

Sheldon Weinhaus
Representing Patients in Medical Necessity Cases
Mr. Weinhaus is a partner in Weinhaus and Dobson, St. Louis, Missouri. He specializes in health insurance contract lititigation and is a Member of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. He is also lead counsel in Geissal v. Moore Medical Corp., a case in which the Supreme Court granter certiorari earlier this year.

John T. Boese
When Angry Patients Become Angry Prosecutors: Medical Necessity Determinations and the Qui Tam Law
Mr. Boese is a partner at Fried, Frank, Harris, Shriver & Jacobson, Washington D.C. He specializes in white collar criminal law and qui tam and false claims litigation. He is author of Civil False Claims and Qui Tam Actions published by Aspen Hall Law & Business.

Richard White, M.D.
Medical Director, United HealthCare of the Midwest

Debra Carnahan
Assistant U.S. Attorney, Eastern District of Missouri

Jeanne Cantalin
Director of Legal and Risk Management Services, Saint Louis University Hospital

Tracy Mathis
Lewis, Rice & Fingersh, P.C.

Lynn Monahan
Compliance Coordinator, SLUCare