From Gray Areas to Red Flags: Hot Topics in Fraud & Abuse

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Speakers:

Randi Seigel PartnerManatt, Phelps & Phillips, LLP

Randi Seigel

PartnerManatt, Phelps & Phillips, LLP

Raul Ordonez Vice President & Chief Compliance OfficerJackson Health System

Raul Ordonez

Vice President & Chief Compliance OfficerJackson Health System

Richard Golfin III Chief Compliance & Privacy OfficerAlameda Alliance for Health

Richard Golfin III

Chief Compliance & Privacy OfficerAlameda Alliance for Health

Scot Hasselman PartnerReed Smith LLP

Scot Hasselman

PartnerReed Smith LLP

About this Session:

Welcome to the fraud & abuse frontlines—where the rules are murky, the penalties are steep, and both payers and providers are under the microscope. As enforcement ramps up in 2025, stakeholders on both sides of the table need to stay ahead of shifting risk.This panel unpacks the top red flags in today’s compliance landscape: from virtual care billing and risk adjustment practices to physician compensation models, behavioral health audits, and value-based care arrangements. We’ll dive into what’s triggering investigations, how payers and providers are getting caught in the crossfire, and what it takes to avoid reputational and financial fallout.

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