| AI and The False Claims Act –Billing and Coding Landmines to Avoid, Plus the Recently Proposed CHAI Standards
Presenter: Rachel Rose, JD, MBA
Time: 50.53 minutes
Description: There are five core principles of AI in healthcare, including data privacy. Rachel Rose, Attorney at Law, examines both benefits and challenges of AI in healthcare, focusing on how to prevent false claims and statements to maintain security and privacy.
Objectives: -
Understand generative AI – with positive, neutral, and negative considerations.
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Explore the intersection of AI and the False Claims Act with a specific emphasis on how it applies to the healthcare sector.
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Identify potential billing and coding landmines to avoid with AI.
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Recognize CHAI standards.
Key Topics: -
Generative AI—Positive, Neutral, and Negative Considerations
• NIST Definition(s) of Artificial Intelligence
• ISO Definition – Generative AI
• NIST Definition of Algorithm
• Blueprint for an AI Bill of Rights
• AI – POSITIVE
• AI Neutral Approach - Benefits and Challenges
• AI – NEGATIVE
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The Intersection of AI and the False Claims Act With a Specific Emphasis on How It Applies to the Healthcare Sector
• Healthcare Fraud and AI
• Sample Generative AI Physician Directive
• Potential Fraud Implications
• GenAI and Images
• Consider the CMS Form 855, Form 1500, and Form UB-04 Attestations, as Well as Interoperability Monies Received
• The False Claims Act
• Recent FCA Data
• Doe v. eviCore Healthcare MSI, LLC , No. 22-530-CV, 2023 WL 2249577 (2d Cir. Feb. 28, 2023).
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Potential Billing and Coding Landmines to Avoid with AI
• Landmines to Avoid
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CHAI Standards
• Coalition for Health AI (CHAI) – Assurance Guide – 2024
• CHAI 5 Core Principles
• Notable Items from CHAI
- Concluding Thoughts
• Concluding Thoughts
• Resources
Speaker
Rachel V. Rose, JD, MBA - Principal.
https://www.rvrose.com/
Ms. Rose has a unique background. Throughout her career, she has accumulated knowledge in a multitude of fields, with an emphasis on various facets of healthcare. Her experiences include: - working on Wall Street and at one of the "Big Four" consulting firms;
- producing for the Chairman of the Reform and Oversight Committee on Capitol Hill;
- interning at the Department of Health and Human Services;
- compiling policy papers at the Royal College of Nursing in London;
- consultative work as a top performing representative for the pharmaceutical and medical device industry;
- clerking for the Honorable Linda R. Allan (6th Judicial Circuit, FL).
Prior to opening her law firm, she was Director of Business Development and Assistant General Counsel for a healthcare advisory company.
She is extensively published and presents on a variety of healthcare, False Claims Act and securities law topics including: cybersecurity, qui tam, physician reimbursement, ICD-10, access to care, anti-kickback and Stark laws, U.S. Supreme Court cases impacting the medical device industry, international comparative healthcare laws, and the HIPAA/the HITECH Act.
Presently, she is the immediate past-chair of the Federal Bar Association's Corporate and Associations Counsel Division (2014-2016), one of eighteen lawyers, who serves on the Federal Bar Association's Government Relations Committee. Ms. Rose has co-authored The American Bar Association's books - The ABCs of ACOs and What Are International HIPAA Considerations?, as well as being a co-editor of American Health Lawyers Association’s Enterprise Risk Management Handbook (2nd Edition). Ms. Rose is also an Affiliated Member of the Baylor College of Medicine's Center for Health Policy and Medical Ethics, where she teaches bioethics and is on the University of Houston Law School's Healthcare Law Advisory Board.
Education - Bachelor of Arts- History (The Pennsylvania State University)
- Master of Business Administration (Vanderbilt University)
- Doctorate of Jurisprudence (Stetson University College of Law); Editor, The Journal of International Law and Aging
Honors and Awards - National Scribes Award
- The William F. Blews Pro Bono Service Award
- Federal Bar Association Fellow
- Named to Texas Bar College
- National Women Trial Lawyers Association - Top 25,, 2018 and 2019
- Houstonia Magazine's Top Lawyers- Healthcare Law, 2018 and 2019
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