What do the Stark laws, the False Claims Act and the Health Insurance Portability and Accountability Act have in common?
They all cause headaches for providers, some might say. But according to Neil Caesar, a healthcare attorney and president of the Health Law Center in Greenville, S.C., they all reflect the government's attitude toward healthcare fraud.
Caesar will explain his views in his presentation "Avoiding Fraud and Abuse" at 4 p.m. Tuesday, March 9, and at 10: 30 a.m. Wednesday, March 10.
"The purpose of the speech is not to talk about all the laws out there, because that all blurs together, and then people leave confused," Caesar says. "It's to help them understand the logic behind the laws so they can develop plans for compliance.
"The idea is to be more of a clarifying program," Caesar adds. "The law is not a collection of individual rules so much as a system of rules with an internal logic."
To show how the government identifies fraud, Caesar will use real-life examples of providers who have found themselves in hot water.
"I wanted to talk about what has happened vs. what could happen in theory," he says.
Those examples also show that it isn't always easy to prove good intentions and that good intentions don't constitute a strong defense when providers face prosecution.
"This (compliance) is not about having a pure heart," Caesar says. "It's about having a system of red flags to warn you that there might be a problem."
Caesar promises to provide tips to remember and suggestions for an action plan.
"Hopefully, when people come out of this (presentation), they'll have their antennae up and active," he says.
One piece of advice: "Watch out for the weakest link in your organization. The people you work with can come back to haunt you."
Caesar spent 18 years in private practice, heading healthcare groups at law firms in Pennsylvania and North Carolina. He also served as corporate counsel to Abbey Healthcare Group, the predecessor of Costa Mesa, Calif.-based Apria Healthcare Group.
In 1994, he founded the Health Law Center, a national company geared toward the healthcare industry.
"Our niche is to serve as the legal experts and counsel to our clients," Caesar says. "We try to personalize our relationships with them."
Caesar, an ACHE veteran, has also addressed fraud issues at conferences of the American Hospital Association, the American Health Lawyers Association and the Medical Group Management Association.
Caesar is writing a book titled "The Medicare Compliance Plan," to be published by McGraw-Hill later this year.
He earned his law degree from the University of Virginia and his undergraduate degree at Washington University in St. Louis.