Health Care Fraud: Investigation and Prosecution (Kaufman)
Faculty
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| Paul Kaufman Adjunct Professor of Law paul.kaufman2@usdoj.gov |
Additional Information
Skills Training
Oral Presentations
Other Professional Skills:
Grading
20% Participation,
80% Exam,
Other (Grading is based on a final exam, but students' grades may move up or down based on participation approximately one partial grade level (A- to A, B+ to A-, etc.). Students in the MBE program, the ML program, or from outside the law school, and/or other students who require a third credit for program reasons must complete an assignment with a research component, white paper for distribution to the class, and in-class presentation. A third credit is not available to traditional JD-only students.)
Exam
Short Answer,
Essay,
Take Home,
Open-Book
No
I am willing to work with students toward the fulfillment of writing requirements, but those arrangements must be made separately and will be registered as an independent study. I will typically not take on this responsibility for a student until after class has concluded, because many/most students don't have the knowledge base to complete a senior-writing level paper until they have completed most or all of the class, but I am willing to discuss exceptions.
Class meets in person.
Course Continuity
Students are encouraged to stay home if you are ill or experience flu-like symptoms. If you miss a class for any reason, it is still your responsibility to make up the work missed.
I offer the following to students who miss class due to illness:
- I have asked for volunteers in the class who are willing to take and share their notes on a regular basis with others who are absent due to illness or some other unavoidable circumstance.
- If you are absent, due to illness or some other unavoidable circumstance, email me and I can ask for volunteers among your classmates to share their notes with you.
- I will make PowerPoint slides or other class materials routinely available on the course site to everyone in the class.
- If you are absent due to illness or some other unavoidable circumstance, email me and I can make PowerPoint slides or other class materials available to you.
- When you are better, please make an appointment to meet with me and I will review/answer questions about what you missed.
- Historically, class attendance has a very strong correlation with class success. With that said, as noted above, I am a professor who understands that real life intrudes and, indeed, one who has left hundreds of thousands of dollars on the table in my own personal life to be able to have a balance between my work life and the family I love. So when the days come where you have to attend a particular event, or something in your personal life breaks, or your sister is getting married, or you just *can't* that day, know that you have my full support. I will hold regular office hours after class and will be available via email and telephone to respond to questions and requests for clarification, both for students who have missed class periods and those who have not. We will have a TA available to provide additional assistance or to answer any questions during time I am not physically present on campus. I am deeply committed to mentoring and to the importance of office hours, so I routinely meet in person or virtually before or after class with students who missed class to review materials . In addition, our TA is excited to assist in this process and is broadly available on campus. *Especially* during the time of COVID, students who are ill or experiencing flu-like symptoms or are febrile are encouraged to stay home. We will make it work for you. It's not worth endangering your health or that of your fellow students. When you are better, please make an appointment to meet with me and/or the TA and I will review/answer questions about what you missed. If you are forced to miss class due to illness, recruiting events, or any other cause, PowerPoint slides and other class materials are available on the course site to everyone in the class. I will also ask for volunteers in the class who are willing to take and share their notes on a regular basis with others who are absent.
Meeting Times/Location
W 6:40PM - 9:30PM
Gittis Hall 213
Category
Upper-Level
Credits
3.0
*To receive a third credit, joint degree and non-JD students may elect to give an oral presentation on an approved topic of their choosing. Traditional JD students do not have the option for a third credit.
This is a course in the investigation and civil and criminal prosecution of health care fraud. We will discuss the principal statutes and regulations governing health care and how those who defraud our health care system are discovered, investigated, and prosecuted. In addition, we will examine the challenges of such investigations and the ways in which prosecutors and defense counsel can overcome those challenges and benefit their respective clients.
This class WELCOMES participation by non-traditional law students, joint degree (MBE or other) students, and students from across the Penn community in nursing, medicine, business, or otherwise. This class is taught using a variety of materials, including federal agency guidance, statutes, regulations, and litigation documents, not just cases, and we have a TA who assists those from non-traditional backgrounds to adjust. Experience in health care law is not required for any student.
Your professor is a prosecutor, and we focus on practice and practical reality, not theory: how fraud is detected, how it is investigated, and how institutions could, should, and do respond to compliance imperatives and/or allegations of fraud.
The class will be divided into three segments. First, we will discuss the criminal, civil, and administrative regulation of health care and the authorities enforcing those rules. Second, we will discuss the methods by which fraud is investigated and their limitations. And, third, we will apply the knowledge gained in the first two segments to specific areas of health care enforcement (devices, pharmaceuticals, hospitals, etc.).
We will not be using a textbook, because that's expensive, and this area of law is replete with interesting, publicly available secondary sources. Course materials will be made available electronically. Recommended materials will be identified for students who are looking to round out the issues we discuss in class or complement their understanding.
Grades will be based principally on a final examination. However, I will conduct this class with a mix of lecture/PowerPoint presentations, class discussion, and soft Socratic teaching methods. Class participation will be considered in determining final grades, up to one third of a grade (i.e. an A- exam/paper can become an A final grade or a B+ exam/paper can become a B final grade based on participation).
Attendance is expected, but to the extent that life interferes, absences will be permitted in accordance with Penn policy. If you know of such absences in advance, you are encouraged to reach out so that we can ensure that you do not fall behind.
I seek to avoid cold-calling on students, but I will when no one volunteers. Any student who lets me know in advance is exempt from any cold-calling. There is no penalty for waving off participation once or twice, although repeated election not to join discussion could impact the participation grade.
I will be discussing statutes that I enforce, so class will not be recorded except in exceptional circumstances or to address pandemic-related concerns. We will have optional mid- and end of semester review sessions. Class may run a half hour late on several weeks to make up time lost to fall holidays (e.g., no class Thanksgiving Wednesday). Students may leave early on any of those days without penalty.
Office hours will be by appointment or before or after class, since I do not have a Penn office, and clarifying questions or other forms of engagement are welcome. I love teaching, I love my students, and I will do whatever I can to make the experience as enjoyable and useful to you as I can.
Criminal Law and Procedure Learning outcomes: Demonstrate a core understanding of criminal law and procedure; Perform legal analysis in the context of criminal law and procedure; Communicate effectively on topics related to criminal law and procedure; Demonstrate an understanding of the role criminal law and procedure play in society and their impact on other areas of law and society.
Health Law Learning outcomes: Demonstrate a core understanding of health law and policy; Perform legal analysis in the context of health law and policy; Communicate effectively on topics related to health law and policy; Demonstrate an understanding of the interconnection among health law and policy and issues of access to services, public and private financing of health industries, and the political and economic issues surrounding issues of health law and health services.
Administrative and Regulatory Law Learning outcomes: Demonstrate a core understanding of administrative and regulatory law and the administrative process, including the role of statutory authorization and work of administrative agencies; Perform legal analysis in the context of administrative and regulatory law; Communicate effectively on topics related to administrative and regulatory law; Demonstrate an understanding of the role administrative and regulatory law play in our legal system and in society as a whole.