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New Insights and Enforcement Risks for Medical Centers Related to CMS National Coverage Determinations, Evidence Based Medicine, and Medical Necessity

17 Dec 2012, 1:00 PM - 2:30 PM (Eastern Time)                            

On Monday, December 17, 2012, at 1:00 - 2:30 P.M. Eastern Time, King & Spalding will host an Atlanta-based Roundtable focused on the implications for medical centers of the recent nationwide enforcement actions by the U.S. Department of Justice (DOJ) regarding alleged violations of a CMS National Coverage Determination (NCD). We also will discuss challenges related to a brand new NCD, and rapidly evolving federal and state enforcement activity based on allegations of “unnecessary medical procedures.” Finally, we will also discuss practical tips to help hospital leadership identify and address potential risks and engage all stakeholders.

We are also offering a Webinar option for the Roundtable. (This Roundtable was originally scheduled for October 29, but was postponed due to Superstorm Sandy.)


  • Lynn Adam
  • Dennis Barry
  • Beverly Lorell, M.D.
  • Mark Polston


The Roundtable will include the following topics:

  • The evolution of CMS National Coverage Determinations: A brief primer
  • The nationwide DOJ hospital investigation—including the DOJ Medical Review Guidelines/Resolution Model—regarding the NCD on implantable cardiac defibrillators
    • New tools in the enforcement toolbox
  • Lost in translation: How to recognize and address the disconnect between rapidly changing practice-of-medicine and enforcement risks
    • Just around the corner: Preparing for the 2012 NCD on transcatheter aortic valve replacement
  • “Unnecessary medical procedures”: Implications of rapidly evolving federal and state enforcement actions
  • Practical suggestions to identify and mitigate risks, including
    • Implementing compliance tools, patient notifications, medical necessity peer review, and voluntary self-disclosure

In-person attendance is limited, so please register soon to reserve seats for your organization. You do not have to be a client to attend, and there is no charge.

You can register to attend in person or by Webinar by clicking the Register link at the bottom of this page. If you are attending in person, lunch will be provided between 12:00 p.m. and 1:00 p.m. if you would like to arrive early for that.

General information on our practice is available on the K&S Website and in our electronic publication Serving the Healthcare Industry. If you would like to be included on our regular healthcare practice mailing list to receive notices of other events and written updates, you can be added by submitting your full contact information to


Offices of King & Spalding
1180 Peachtree Street, NE / 16th Floor
Atlanta, GA 30309


If you have questions concerning this Roundtable, contact Marie Parks at