LibGuides: Healthcare Law: Fraud and Abuse/False Claims in Health Care

Fraud and Abuse Investigation

Healthcare Fraud Investigation Guidebook by Charles E. Piper
Call Number: Available via ProQuest Ebook Central
ISBN: 9781138415591
Publication Date: 2017-07-27
Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper's Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to "investigate" and prove the wrongdoing to increase the likelihood of successful prosecution in court.The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper's unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides:Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspectsTips on investigative case planning, goals, and strategiesSample visual aids for use when briefing others about your investigative findingsGuidance on presenting information obtained from healthcare investigations and on how to testify in courtTechniques for uncovering previously undetected fraudThe book includes a sample case study that walks readers through a mock case from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper's proven methodology.Sharing insights gained through Charles Piper's decades of experience as a federal special agent and certified fraud examiner, th
Fraud and Abuse Investigations Handbook for the Health Care Industry by Paul W. Shaw, Robert A. Griffith
Call Number: OU Law does not currently provide access to this resource.
ISBN: 9781663315007
Publication Date: 2021 (2nd ed.)
The American Health Law Association and Authors Paul W. Shaw and Robert A. Griffith have revised this new and necessary Handbook, bringing not only their prior experience as prosecutors, but also decades of experience as private practitioners representing health care businesses and professionals under federal and state criminal and civil fraud and abuse investigations. 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.

Description

These resources covers federal physician self-referral law, commonly known as the Stark Law, and fraud and abuse law. he sources address statutes, regulations, and advisory opinions that define the parameters of physician referrals and anti-kickback laws, analyzing fraud and self-referral issues. Sources also assist users in familiarizing themselves with the False Claims Act and other laws, regulations, and government regulatory actions designed to combat false claims and other types of fraudulent activities.

Database Resources

Westlaw Edge - American Health Law Association Seminar Papers - Fraud and Compliance Forum

Practical Law on Westlaw Edge - Fraud Abuse & Compliance

Bloomberg Law - Health Care Fraud Analytics

Bloomberg Law - Health Law & Business Portfolios include:

Portfolio 1500: Federal Anti-Kickback Law - This portfolio closely examines the federal anti-kickback statute that prohibits payments as inducement for referrals of Medicare or Medicaid beneficiaries: the statute's goals and terms, its extensive regulatory exceptions, and its interpretation by regulators and the courts. Potential anti-kickback problems in specific types of health care business arrangements are emphasized throughout the portfolio.

Portfolio 2400: Federal Self-Referral Law - This portfolio examines in detail the federal statute commonly referred to as the Stark law, which places significant restraints on referrals of patients for Medicare-covered designated health services to an entity with which the referring physician (or a member of the physician's immediate family) has a financial relationship. The portfolio analyzes the complex definitions, numerous statutory and regulatory exceptions, and limits on applicability that complicate this statute's seemingly simple prohibition, emphasizing both formal and informal regulatory interpretations as well as the statutory language.

Portfolio 2600: Health Care Fraud and Abuse: Enforcement and Compliance - This portfolio analyzes the complex world of health care fraud and abuse enforcement, both criminal and civil: who is investigating, what they are looking for, and the elaborate web of statutes and regulations under which they are proceeding. The portfolio emphasizes, as well, how providers can respond in an enforcement-prone environment, try to avoid compliance problems in the first place, and to minimize the impact if violations occur.

Portfolio 2650: The False Claims Act: Health Care Applications and Defenses - This portfolio address the complex legal issues surrounding False Claims Act litigation in the health care sector. It emphasizes effective strategies for successfully defending False Claims Act lawsuits and allegations commonly asserted against companies and individuals in the health care industry. This portfolio also offers guidance on effectively handling a government investigation, settling FCA claims, and limiting liability through voluntary disclosure of potential False Claims Act violations and provides an analysis of how courts calculate damages and penalties in specific health care situations.

Healthcare Fraud & Abuse

Health Care Fraud and Abuse by Linda A. Baumann
Call Number: This title was last printed as Health Care Fraud and Abuse: Practical Perspectives, Third Edition with 2018 Cumulative Supplement and is current through a 2020 update digitally via Bloomberg Law
ISBN: 9781617463013
Publication Date: 2013-01-01
An introduction to health care fraud and abuse / Linda A. Baumann -- Federal physician self-referral restrictions / Robert H. Homchick -- The false claims act in health care prosecutions : application of the substantive, qui tam, and voluntary disclosure provisions / Robert Salcido -- Practical considerations for defending health care fraud and abuse cases / Patric Hooper and Tracy Jessner -- Legal issues surrounding hospital and physician relationships / David H. Hilgers and Ana E. Cowan -- Care fraud and abuse : risk areas for government program participants / Richard W. Westling -- Corporate compliance programs / Linda A. Baumann and Samuel C. Cohen -- Potential liabilities for directors and officers of health care organizations / Leigh Walton, Angela Humphreys, and Nesrin Tift -- The past, present, and future of the anti-kickback statute : a practical history / William W. Horton -- Controlling fraud, waste, and abuse in the Medicare part D program / Larri A. Short and Stephanie L. Trunk -- Fraud and abuse issues surrounding clinical trails / Robyn S. Shapiro and Julie M. Rucszek.
Prosecuting and Defending Health Care Fraud Cases by Michael K. Loucks
Call Number: Available via Bloomberg Law
ISBN: 9781682670132
Publication Date: 2016-12-01
A DEFINITIVE GUIDE to investigations and prosecutions in health care fraud cases Prosecuting and Defending Health Care Fraud Cases, Third Edition covers health care fraud from two distinct angles: the applicable law and the federal criminal process for health care fraud cases. This book analyzes trials conducted in a variety of cases, with chapters structured to match the process as it actually takes place during the investigation, after charges are brought, and through sentencing. It presents possible charges, investigative tools, proven trial strategies for both prosecution and defense, considerations for settlement of a prosecution or civil suit, and applicable sentencing factors. The Third Edition includes: analysis of the U.S. Supreme Court decision in Escobar; a thorough review of the current state of balance between the laws and regulations regarding off-label promotion and the right to free speech set forth in the First Amendment; the addition of substantial financial hardship language to the Sentencing Guideline enhancement for multiple victim or mass marketing offenses; discussion of Luis v. United States and the pretrial freezing of a defendant s assets; and more.
Best Practices Handbook for Advising Clients on Fraud and Abuse Issues by Paul W. Shaw; Kristin M. Bohl; American Health Lawyers Association Staff (Contribution by)
Call Number: OU Law does not currently provide access to this resource.
ISBN: 9781522140870
Publication Date: 2017-01-01
Best Practices Handbook for Advising Clients on Fraud and Abuse Issues is a concise guide developed by expert health lawyers with extensive and diverse experience. The authors weigh in on the complex representation issues that health care attorneys commonly confront in the realm of fraud and abuse:

Ethical concerns when counseling in “gray areas”
Privilege protection in fraud and abuse matters
Providing a “fraud and abuse” opinion of counsel
The attorney’s role in conducting internal compliance audits and investigations
Self-disclosure and voluntary disclosure
Gathering documents in response to government demands
Interacting/communicating with employees and potential witnesses
Issues for an attorney to consider in resolving disputes with the government
The Handbook also includes sample documents that readers can use to address many of the issues discussed in this book.

Stark Law

The Stark Law by Charles B. Oppenheim; Ben A. Durie; Amy M. Joseph; American Health Lawyers Association Staff (Contribution by)
Call Number: OU Law does not currently provide access to this resource.
ISBN: 9781522170327
Publication Date: 2019-01-01
From the publisher: More than a summary of the law, this updated edition of an essential monograph offers in-depth critical analysis of this risky, complex area, as well as a wealth of practice pointers and advice for advising clients. Written by leading experts in the interpretation and application of Stark Law, the latest edition of The Stark Law: Comprehensive Analysis + Practical Guide analyzes the following topics:

The definition of entity
Split/shared evaluation and management services
Timeshare agreements
Valuing goodwill in physician practice acquisitions
Joint marketing
Fair market value assessments
"Stand in the shoes" when contracting with a group
When a collection of documents can constitute a written agreement
Developments on the signature requirement
Revisiting fair market value over the course of a term
Liability under The False Claims Act with respect to Medicaid
Bankruptcy trustees and Stark Law
Updates to the self-referral disclosure protocol