Health Care Fraud and Abuse


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.







Federal False Claims Act and Qui Tam Litigation


Book Description

This book covers the merits of a potential action; determining whether the relator would be barred or restricted from any recovery for retaliation and more.







Fraud and Abuse Investigations Handbook for the Health Care Industry


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.




Whistleblower's Handbook


Book Description

UPDATED IN MARCH 2013 to include the historic $104-million Bradley Birkenfeld whistleblower case and more! From the nation’s leading whistleblower attorney, comes the third edition of the first-ever consumer guide to whistleblowing. In The Whistleblower’s Handbook, Stephen Martin Kohn explains nearly all federal and state laws regarding whistleblowing. In the step-by-step bulk of the book, he also presents twenty-one rules for whistleblowers.




Civil False Claims and Qui Tam Actions


Book Description

Civil False Claims and Qui Tam Actions is an essential weapon for bringing or defending a qui tam action. This Fourth Edition, two-volume treatise provides comprehensive analysis of The Civil False Claims Statute and a balanced approach to every important aspect of case preparation and litigation -- from establishing the merits of a whistleblower claim to determining the formula for arriving at the qui tam plaintiff's award. Civil False Claims and Qui Tam Actions, frequently cited by the courts, is clearly and concisely written to: walk you, step-by-step, through each phase of case preparation, from the perspective of both plaintiff-relator and whistleblower defendant spell out the unique procedural requirements in a civil false claims action -- from the applicability of statute of limitation rules to the scope of discovery under a andquot;civil investigation demandandquot; by the federal government explain how to draft a whistleblower complaint collect, organize and interpret the controlling case law direct you to the relevant statutory whistleblower provisions, rules and regulations that apply to the issues under discussion analyze the legislative history of The False Claims Act and explains why it is essential to the success of a prosecutor's or defense's cause of action and alert you to emerging trends in civil false claims and qui tam actions For the best guidance on how to bring or defend a qui tam action, consult the civil false claims specialist - John T. Boese. John T. Boese is an expert author and litigation partner in the Washington, DC law office of Fried, Frank, Harris, Shriver andamp; Jacobson. with more than 25 years of experience in civil fraud cases, both as a former DOJ attorney and as defense counsel. In a clear and straightforward manner, he offers his expert analysis of recent developments on: The Supreme Court's decision on andquot;original sourceandquot; in Rockwell The recent trend by state legislatures to enact false claims laws that mirror the federal law. The andquot;presentmentandquot; requirement Corporate liability under The Civil False Claims Act Interpreting the public disclosure bar and original source requirement Challenges to sufficiency of FCA complaints under Rule 9(b) The Civil False Claims Act has captured the attention of any organization doing business with the federal government, for very good reasons: Virtually any person that receives, spends or uses federal money may be liable under The Civil False Claims Act. Private individuals, including employees can be whistleblowers on contractor fraud by bringing a qui tam lawsuit on behalf of the federal government - and receive up to 30% of any judgment or settlement. The courts have upheld highly creative claims brought under The Civil False Claims Act. Don't get lost in the maze of changing, complicated, and confusing qui tam provisions, whistleblower rules, and civil false claims regulations!




Healthcare Fraud


Book Description

An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.




Section 1557 of the Affordable Care Act


Book Description

Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.