False Claims Act & the Healthcare Industry PDF Download
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Author: Robert S. Salcido
Publisher:
ISBN: 9781663386311
Category : Fraud
Languages : en
Pages : 0
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Book Description
Author: Robert S. Salcido
Publisher:
ISBN: 9781663386311
Category : Fraud
Languages : en
Pages : 0
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Book Description
Author: Aspen Health Law Center
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 156
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Book Description
Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.
Author: Paul W. Shaw
Publisher:
ISBN: 9781663315007
Category : Fraud investigation
Languages : en
Pages : 775
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Book Description
The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.
Author: David E. Matyas
Publisher:
ISBN: 9781422434369
Category : Health insurance
Languages : en
Pages : 495
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Book Description
Author: Christine L. White (Lawyer)
Publisher:
ISBN: 9781522135210
Category : Antitrust law
Languages : en
Pages : 750
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Book Description
Author: Barry D. Alexander
Publisher:
ISBN: 9781422489611
Category : Medical care
Languages : en
Pages : 564
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Book Description
This specialized and complex field of health law requires a thorough grounding in the basics, and Fundamentals of Health Law, 5th Edition, provides that grounding like no other book on the market does. This new edition has been thoroughly revised and made current to cover the basic issues of health law practice, from patient to facility issues, from permits and regulation issues to compliance and investigation issues, and includes issues raised by new laws, regulations and guidelines promulgated since the fourth edition in 2008, including the Affordable Care Act (ACA). This publication covers fundamental legal principles and issues to assist: * New Practitioners or experienced attorneys entering their first years of health-law practice; * Professors of health law searching for a comprehensive text for their students; and * Users of any law library looking for answers on the health law resource shelf.
Author: American Health Lawyers Association
Publisher:
ISBN: 9781522173441
Category :
Languages : en
Pages :
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Book Description
Authored by experts with years of health care compliance experience, this new edition integrates changes in regulation, trends in enforcement, and the reasoning of the courts to help you navigate emerging and unsettled areas of compliance risk, such as self-disclosure obligations, risks associated with opioid use, and the impact of statistical sampling.Highlights of this edition include:All new glossary of health care compliance terms, including key statutes, acronyms, governing agencies, and moreExpanded civil monetary penalty and exclusion authorities under 2017 final rulesDiscussion of core elements of compliance programs for Medicare Advantage Plans and Part D Plans as established by federal regulationsExpanded whistleblower protections under federal and state law, false claims based on lack of medical necessity, materiality after Escobar, and recent enforcement activityExpanded discussion of determinations of medical necessity, CMS review of medical necessity terminations, consequences, and appeals processesRecent health information privacy and security developments, including new guidance, risks associated with innovative technologies, and trends in Health Insurance Portability and Accountability Act (HIPAA) enforcement activityNew chapters:Chapter 1, Glossary of Key TermsChapter 10, The Relationship between Enforcement and ComplianceChapter 17, Health Care Civil Rights and Nondiscrimination Under Section 1557 of the Affordable Care ActChapter 19, Behavioral Health
Author:
Publisher:
ISBN: 9780327175308
Category :
Languages : en
Pages :
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Book Description
Significant events have occurred regarding the government's enforcement and administration of the False Claims Act (FCA) in the last few years. The government has continued to negotiate major settlements against healthcare entities, and the courts have issued numerous decisions that impact the manner in which healthcare businesses are organized and operated. In 2012, the Department of Justice announced that $3 billion of the $5 billion recovered under the FCA was health-related. With these recent developments in FCA litigation and the rapidly developing case law, you will need the Second Edition of False Claims Act & the Healthcare Industry and the 2014 Cumulative SupplementThis authoritative treatise will keep you up-to-date on the latest FCA developments so that you can more effectively advise your client on how to assess their company's potential exposure to liability, evaluate the exposure of companies that they may acquire, and reform company practices to reduce the risk of potential FCA liability.EXPERT ANALYSIS: THE ELEMENTS THAT CREATE LIABILITY UNDER THE FCAWhat does it mean to "Present or Cause to Present" a false claim?How do courts determine whether a claim is "False or Fraudulent"?How does one "know" under the FCA, that a claim is "False"?When is a claim "Material" to the government's determination to pay?LEADING DEFENSES THAT RESULT IN THE DISMISSAL OF QUI TAM ACTIONSWhen are lawsuits barred under the FCA public disclosure bar?What must the whistleblower prove to show that she qualifies as an "original source"?Under what circumstances do courts dismiss actions for failure to state fraud with specificity under Fed.R.Civ.P.9(b)?Under what circumstances does a plaintiff fail to show that defendant submitted a "false" claim or statement under the FCA?Under what circumstances does a plaintiff fail to establish that the defendant "knew" that a claim wa false or fraudulent?FCA DAMAGESHow do courts compute FCA damages in Healthcare upcoding cases and in cases alleging a violation of the FCA because of a violation of the Anti-Kickback or Stark Law?What are the limits courts may impose on the government's or whistleblower's ability to recover FCA damages?FCA STATUTE OF LIMITATIONSHow do courts compute the FCA statute of limitations?VOLUNTARY DISCLOSURES TO THE OIGUnder what circumstances should a company consider submitting a voluntary disclosure?What is the process underlying the submission of a voluntary disclosure?What are the potential benefits and risks associated with submitting a voluntary disclosure?THE FCA WHISTLEBLOWER RETALIATION PROVISIONWhat does a retaliated against "whistleblower" need to prove to obtain damages from the employer?The eBook versions of this title feature links to Lexis Advance for further legal research options.
Author: Ela Bochenek
Publisher:
ISBN: 9781522178026
Category : Drugs
Languages : en
Pages : 319
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Book Description
A robust compliance program is essential to protecting a company from running afoul of the myriad laws and regulations that have been enacted to combat fraud and waste. The second edition of the Pharmaceutical and Medical Device Compliance Manual includes guidance to help companies develop a compliance program tailored to today's complex enforcement and business environment. Study of this Manual will enable compliance professionals and lawyers to understand the government's expectations of an effective compliance program and ethical business practices, as well as: how the government discovers potential enforcement actions, its approach to pursuing such actions, what behaviors can constitute mitigating factors for a company in the event of a legal violation. Coverage includes new chapters covering:Pharmaceutical industry interactions with patient organizations Compliance 2.0: compliance analytics in the era of big dataThe art and science of health care compliance in the pharmaceutical and medical device industries The Manual will be a great tool for health and life sciences attorneys, compliance officers, and others in the pharmaceutical and medical devices industry
Author: American Society for Healthcare Risk Management (ASHRM)
Publisher: John Wiley & Sons
ISBN: 0470443715
Category : Medical
Languages : en
Pages : 672
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Book Description
Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available. American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments.
