S. Health Care Fraud

Health care fraud results in significant financial loss to consumers, government, and private plans, and in serious harm to patients. This course studies health care fraud schemes and federal and state criminal, civil, and administrative efforts to detect, investigate, prosecute, and prevent fraud. We consider challenges in public and private health plans, fee-for-service, and managed care. Each student may choose to focus on a particular health care provider such as nursing homes, substance abuse and mental health programs, and hospitals.

The course’s focus on health care fraud also serves as a way to explore a wide range of subject matters. We will examine general white collar crime matters such as whistleblower qui tam suits, parallel proceedings, compliance, and the effect of changing federal administrations on enforcement practices. We will consider how health care fraud and the efforts to redress it implicate quality of care, privacy, and equity. Finally, the seminar concludes with an exploration of how traditional fraud detection and enforcement has been challenged by recent developments such as the opioid crisis, COVID-19 and technological change in telemedicine, mobile applications, and artificial intelligence.

PREREQUISITES: None.

COURSE EXPECTATIONS: Students will submit brief weekly reflections on the reading. Class discussion is encouraged. Over the semester, students will participate in simulations applying the course material to practical scenarios such as interviewing a whistleblower, counseling physicians affiliated with academic medical centers, and advising a public health agency responding to COVID-19.

The course requires a paper with a topic selected by the student approved by the instructor by Week 7. This paper can satisfy minor or major writing credit.