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Health Care Fraud: Pandemic Impacts and Financial Implications for the Industry

Level: Advanced
Runtime: 61 minutes
Recorded Date: December 10, 2021
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• Increase in Healthcare Fraud during the Pandemic
• Background
• Types of Healthcare Fraud
        - Provider Fraud
        - Inflated Billings
        - Kickbacks
        - Fraud by Medical Instutions
        - Fraud in Special Care Facilities
        - Insured and Beneficiary Fraud
• Healthcare Fraud Case Studies

: 1 hour
Recorded: December 10, 2021

For NY - Difficulty Level: For both newly-admitted & experienced attorneys (transitional)


COVID-19 spurred unprecedented levels of government support. Through Provider Relief Funds, Medicare Advanced Payments, PPP loans and other mechanisms, federal agencies provided substantial liquidity, in some cases with strings attached. Join the panelists as they delve into the effects these funds might have had on fraud and abuse in the health care space.

This program was recorded as part of ABI's 2021 Winter Leadership Conference on December 10th, 2021.

Provided By

American Bankruptcy Institute
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Frederick J. Kohm, Jr.

Partner, Forensic Advisory Services Practice
Grant Thornton, LLP

Frederick J. Kohm, Jr., CPA, CFF is partner in the Forensic Advisory Services practice of Grant Thornton LLP in Philadelphia. In this capacity, he leads large complex investigations, forensic accounting services and corporate compliance engagements in various industries for public, privately held and nonprofit organizations.

Mr. Kohm has more than 25 years of financial and accounting experience across various industry sectors. Prior to joining Grant Thornton, he was a senior managing director for an international public accounting firm, where he led its business valuation and forensic advisory services practice in Philadelphia. He has also held financial accounting positions in the private sector. As an expert witness, Mr. Kohm has testified in federal and state court in both bench and jury trials. He has testified as an expert in arbitration and assisted clients in mediation. In addition, he has been appointed independent monitor by federal regulators, and appointed inspector by the Bermuda Monetary Authority. In addition, he has also served clients as an independent arbitrator, assisting clients with purchase-price and working-capital disputes. While leading large complex forensic accounting and investigative engagements, Mr. Kohm serves his clients by providing consulting expertise and managing engagement teams in the U.S. and across the globe. In this capacity, he regularly works with colleagues in the U.S. and other countries investigating corporate compliance matters, bribery and corruption, and white-collar crime.

Mr. Kohm has served on committees for the Pennsylvania Institute of Certified Public Accountants (PICPA), including the Forensic and Valuation Committee, Financial Services Committee and Insurance Industry Committee. He currently is chair of the PICPA Insurance Industry Committee and a frequent speaker at professional events and Philadelphia-area universities. Mr. Kohm received his B.S. in business administration from Millersville University.

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J. Richard Kiefer

Co-Chair, White Collar Crime & Government Investigations Practice Group

J. Richard Kiefer is co-chair of Dentons’ national White Collar Crime & Government Investigations Practice Group and is based in Indianapolis. A veteran of approximately 100 jury trials in state and federal courts and dozens of state and federal appeals throughout the country and over 200 internal investigations, he has experience representing clients in cases involving health care fraud, tax fraud, mail fraud, wire fraud, money laundering, currency structuring violations, securities fraud, antitrust violations, environmental crimes, public corruption and bribery, and myriad other federal and state criminal offenses.

Mr. Kiefer is a former international banker in both the U.S. and London and a former manager of a foreign exchange trading department. His health care practice includes representing clients in both civil and criminal health care fraud investigations and litigation, including alleged violations of the False Claims Act, Anti-Kickback statute, and myriad health care fraud criminal statutes. His clients have included Fortune 500 companies, some of the nation’s largest long-term-care chains and assisted living companies, durable-medical-equipment companies, home health care companies, hospitals, physicians, psychiatrists, pharmacists, eye surgeons, dentists, podiatrists, chiropractors, nurses and other health care providers, as well as business executives, public officials and professional athletes. Mr. Kiefer chairs a CARES Act SBA Audit & Government Investigations Defense Team that has represented clients throughout the country in SBA audits of Paycheck Protection Program (PPP) loans. He has conducted webinars and has written extensively on preparing for and defending PPP loan audits, specific audit issues, strategic considerations and statutory and regulatory legal issues. Much of

Mr. Kiefer’s practice involves joint defense efforts in multidefendant cases in which lawyers for various targets or charged defendants cooperate in a joint defense strategy to defend their respective clients. He has experience in representing clients in complex cases involving inter-related criminal, civil and administrative proceedings. He also advises corporate clients on corporate compliance programs and has negotiated national Corporate Integrity Agreements with the Office of Inspector General of the U.S. Department of Health and Human Services, and he has represented clients in investigations by and proceedings before the Department of Justice, Department of Defense, Department of Homeland Security, Environmental Protection Agency, Department of Agriculture, Drug Enforcement Administration, Securities and Exchange Commission, and numerous state governmental agencies.

Mr. Kiefer is a life member of the National Association of Criminal Defense Lawyers (NACDL) and is a former president of the Indiana Association of Criminal Defense Lawyers and Chairman of the Criminal Justice Section of the Indiana State Bar Association. He also is a frequent faculty member at national seminars on criminal defense, health care fraud and trial strategy, and he has authored numerous articles in professional publications.

Mr. Kiefer received his B.A. in political science and international relations from Purdue University in 1970 and his J.D. cum laude in 1975 from Indiana University Robert H. McKinney School of Law.

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Mark E. Andrews

Managing Director
Trinity River Advisors

Mark E. Andrews is a managing director with Trinity River Advisors in Dallas and has more than 35 years of experience representing clients in all aspects of insolvency work, including out-of-court restructurings and representations in state and federal court with a focus on bankruptcy-related matters. He previously was a named partner in a prominent Dallas-based bankruptcy boutique, then joined Cox Smith, later Dykema, where he served on its management committee and was head of the firm’s bankruptcy and creditors’ rights section.

Mr. Andrews has worked on behalf of debtors, secured lenders, unsecured creditors, creditors’ committees and trustees. He has also represented investors and buyers of assets in bankruptcy court.

Mr. Andrews has represented clients in the aviation, energy, health care, restaurant chain retail chain industries. He has appeared in cases in courts across the U.S., including New York, Wilmington, Del., Chicago, New Orleans, Oklahoma City, Albuquerque, N.M., and in courts all over Texas. His representative lender clients have included JP Morgan Chase, Comerica Bank, City Bank Texas and Texas Capital Bank, among others, and his typical representations were as secured lender with cash-collateral and post-petition-financing issues. As debtor’s counsel in energy cases, he most recently represented New Emerald Energy, Murphy Energy and Northstar Energy, and he has experience in E&Ps, midstream and specialized energy servicers. As debtor’s counsel in health care cases, he has represented a number of physicians’ practice groups and retirement communities, and he has represented investors in the acquisition of restaurant chains in Texas and California. In addition, he has advised corporations on the effect of bankruptcy on their business, including Hunt Oil, General Motors, a private company in the restaurant-supply business, a private company in telecommunications business, and many others.

Mr. Andrews is a trained mediator and periodically mediates disputes. He is admitted to practice law in the State of Texas, and is admitted to practice before Federal District Courts in Texas, New Mexico, Louisiana, Delaware and New York.

Mr. Andrews is a Fellow in the American College of Bankruptcy and has been listed in The Best Lawyers in Texas and The Best Lawyers in America for many years. He also is ranked in Chambers USA. Mr. Andrews received his Bachelor’s degree in American/United States Studies/ Civilization in 1980 from Georgetown University and his J.D. in 1983 from Tulane University.

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Carol L. Fox, CPA, CIRA, CFA

Senior Managing Director
B. Riley Rinancial

Carol L. Fox, CPA, CIRA, CFA is a senior managing director with B. Riley Financial in Fort Lauderdale, Fla., and has more than 30 years of private and public accounting experience. She previously was with GlassRatner and Kapila & Company, where she focused on forensic accounting, litigation support and bankruptcy.

For nearly 20 years, Ms. Fox’s practice has focused on her career has concentrated on providing forensic, investigative and bankruptcy services to debtors, creditors, federal bankruptcy trustees and examiners, creditors’ committees, court-appointed assignees, the Securities and Exchange Commission, the Department of Justice, law firms and financial institutions. She has provided restructuring and bankruptcy-related services for distressed situations in the health care, life sciences, mining, transportation, e-commerce, real estate, telecommunications, hospitality, agriculture and marine sectors. In addition, she has led high-profile investigations of investment schemes, fraud investigations, internal corporate investigations, due-diligence assignments and matters involving business disputes and quantification of damages.

Ms. Fox is a newly appointed subchapter V trustee for the Southern District of Florida. She has served as a fiduciary in bankruptcy court matters and is currently serving as a fiduciary in state court matters. Additionally, she has testified as an expert witness on numerous occasions in federal and state court including testifying as an expert for the Department of Justice in the chapter 11 bankruptcy of Peabody Energy Corporation, et al.

Ms. Fox has addressed numerous professional organizations on issues relating to bankruptcy, forensic accounting and distressed real estate. In 2019, she was recognized as a Top U.S.A. Woman Dealmaker by the Global M&A Network. She currently serves on IWIRC-Florida’s Board of Directors, representing the South Florida chapter.

Ms. Fox received her B.S. in accounting from the University of Florida.

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