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Health Care Fraud and Abuse Compliance Manual (1-year Online Subscription)

Health Care Fraud and Abuse Compliance Manual (1-year Online Subscription)

Author: Christina W. Fleps
Publisher: Wolters Kluwer Legal & Regulatory U.S. (Online)
ISBN: 10048335
Published In: Subscription-type (Contents updated periodically)
Format: Online , 1750 pages
Jurisdiction: U.S. ? Disclaimer:
Countri(es) stated herein are used as reference only

HKD 6,483.24

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Description
Contents

Details
An immensely practical resource, Health Care Fraud and Abuse Compliance Manual provides a comprehensive overview of legislative and regulatory restrictions that affect the way health care providers conduct business and how they structure relationships among themselves. This treatise helps providers determine the boundaries of permissible conduct under the myriad statutes and regulations that relate to health care fraud and abuse at both the federal and state levels.

Specific coverage includes:
- The statutory language in the Medicare/Medicaid civil money penalties and false claims statutes
- The Medicare/Medicaid antikickback statute
- The Stark "self-referral" law
- The numerous safe harbors and exceptions contained with these prohibitions
- And more!
This authoritative resource will make you aware of your crucial obligations and options. Each chapter of the Health Care Fraud and Abuse Compliance Manual describes what the law requires, how it applies in a health care context, and what the penalties are for failure to comply.

With Health Care Fraud and Abuse Compliance Manual:
- You'll receive coverage of all the critical laws and considerations, including: false claims and fraudulent billings, civil and criminal penalties, the antikickback statute, the safe harbor regulations, the Stark Law, and state statutes
- You'll get practical advice on developing a corporate compliance program that can help you stay on the right side of the law
- You'll learn about the structures, goals, and procedures of agencies that investigate health care fraud
- You'll get an in-depth understanding of what goes into a fraud and abuse investigation - and how you can respond to an investigation to best defend your organization
- And much, much more!
Health Care Fraud and Abuse Compliance Manual has been updated to include:
- Updated nationwide health care fraud and abuse enforcement statistics
- OIG Work Plan for FY 12 (Medicaid projects)
- Enforcement actions involving billing for services of unlicensed personnel
- Enforcement actions involving billing without proper documentation
- Enforcement actions involving illegal inducements to beneficiaries
- Hospital liability for submission of false cost reports
- Cases involving maximum hospital liability for EMTALA violations
- Criminal false claims liability for unsolicited telemarketing by a DME supplier
- Managed care provider liability for cherry-picking, retaining overpayments, and other practices
- Hospice liability for providing services to ineligible patients
- Pharmaceutical manufacturer liability for pricing-related false claims violations
- Enforcement actions involving federal research grant fraud
- Criminal kickback liability for sham consulting arrangements
- Self-referral liability for office lease agreements and independent contractor relationships inconsistent with fair market value or not memorialized in writing
- Updated Medicaid Fraud Control Unit performance standards (MFCU)
- False claims laws of Massachusetts, Montana, and Nevada
- OIG evaluation of Massachusetts, Montana, and Nevada false claims laws
Overview of Health Care Fraud and Abuse

Summary of Health Fraud Offenses and Sanctions

Government Enforcement Programs and Trends

False Claims and Fraudulent Billing

Criminal Penalties for False Statements, False Claims, and Other Fraudulent Billing Activities

Civil Penalties for False Statements, False Claims, and Other Fraudulent Activities

Risks of Potential Civil and Criminal Liability

Exclusion from Federal and State Health Care Programs

OIG Civil Monetary Penalty and Assessment Regulations

Double Jeopardy and Excessive Fines

Fraud and Abuse Prohibitions under the Antikickback Statute

The Antikickback Statute

Provider Risks under the Antikickback Statute

Safe Harbor Regulations

Fraud and abuse Waivers for ACOs

State Law

Federal Physician Self-Referral Prohibitions: The Stark Law

History of the Law and Regulations

Self-Referral Provisions

Sanctions and Enforcement

Reporting Requirements

Distinction Between Antikickback and Self-Referral Legislation

Advisory Opinions under the Stark Law

Provider Risk Areas and Risk Avoidance

Administrative Action and Judicial Interpretations

Corporate Compliance Programs

Liability for Corporate Offenses

The Guidelines and Corporate Compliance Programs

Developing a Compliance Program

Benefits of a Compliance Program

OIG Compliance Resources

Anatomy of an Investigation

Investigators of Health Care Fraud

Investigative Tools

Investigatory Strategies

Origins of an Investigation

Strategies for Responding to a Subpoena

How to Deal with Investigators

Attorney-Client Privileges and Others

Specific Defenses to Investigative Methods Used in Health Care Fraud

Internal Investigations

Managing Documents

Medical Records

Anticipating Health Care Fraud Investigations

Provider Disclosures

The Settlement Process

Report on State Antifraud Enforcement

State Medicaid Fraud Control Units

Fraud and Abuse in Medicaid Managed Care

State Medicaid Agency Fraud and Abuse Plan

State False Claims Acts

State Health Care False Claims Statutes

State Self-Referral and Antikickback Laws

Appendices