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Author : Robert A. Griffith
Publisher :
ISBN 13 : 9780918945433
Total Pages : 424 pages
Book Rating : 4.9/5 (454 download)
Download or read book Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2000 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :
Publisher :
ISBN 13 : 9780769865652
Total Pages : pages
Book Rating : 4.8/5 (656 download)
Download or read book AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry (AHLA Members) written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution
Author : Paul W. Shaw
Publisher :
ISBN 13 : 9781663315038
Total Pages : 848 pages
Book Rating : 4.3/5 (15 download)
Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 848 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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 : Charles E. Piper
Publisher : CRC Press
ISBN 13 : 1498752616
Total Pages : 205 pages
Book Rating : 4.4/5 (987 download)
Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by CRC Press. This book was released on 2016-03-23 with total page 205 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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 suspects Tips on investigative case planning, goals, and strategies Sample visual aids for use when briefing others about your investigative findings Guidance on presenting information obtained from healthcare investigations and on how to testify in court Techniques for uncovering previously undetected fraud The 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, the Healthcare Fraud Investigation Guidebook aims to revolutionize the way that healthcare fraud investigations are conducted. It provides the understanding you need to not only put a bandage on the problem of healthcare fraud, but to actually start curing the greed that is poisoning the healthcare industry.
Author : Paul W. Shaw
Publisher :
ISBN 13 : 9781663315007
Total Pages : 775 pages
Book Rating : 4.3/5 (15 download)
Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 775 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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 : Rebecca S. Busch
Publisher : John Wiley & Sons
ISBN 13 : 1118179803
Total Pages : 374 pages
Book Rating : 4.1/5 (181 download)
Download or read book Healthcare Fraud written by Rebecca S. Busch and published by John Wiley & Sons. This book was released on 2012-05-01 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
Author : Robert Fabrikant
Publisher : Law Journal Press
ISBN 13 : 9781588520739
Total Pages : 1308 pages
Book Rating : 4.5/5 (27 download)
Download or read book Health Care Fraud written by Robert Fabrikant and published by Law Journal Press. This book was released on 2023-12-28 with total page 1308 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Care Fraud: Enforcement and Compliance focuses on fraud and abuse issues involving health care providers as well as application of the laws governing fraud and abuse to manufacturers of drugs and medical devices and other non-providers such as medical researchers.
Author : Aspatore Books Staff
Publisher : Aspatore Books
ISBN 13 : 9780314202376
Total Pages : 336 pages
Book Rating : 4.2/5 (23 download)
Download or read book Responding to Health Care Fraud and Abuse Investigations written by Aspatore Books Staff and published by Aspatore Books. This book was released on 2008 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: Responding to Health Care Fraud and Abuse Investigations is an authoritative, insiders perspective on representing and advising health care organizations facing criminal and/or civil fraud and abuse investigations. Featuring partners from some of the nations leading law firms, these experts guide the reader through the different phases of an investigation and the key considerations for each phase. These top lawyers reveal their advice on how to understand the scope allegations, how to develop an initial response, and how to coordinate an internal investigation and evaluate a clients position, including managing documents and communications with knowledgeable individuals at the organization. From weighing self-disclosure and interacting with government agencies to auditing remedial actions and negotiating settlements, these authors outline steps that can be taken to manage liability during the latter stages of an investigation. Additionally, these leaders discuss recent changes in the regulatory landscape, describe the types of actions that often trigger investigations, and offer best practices for mitigating risk through the implementation of effective compliance programs. The different niches represented and the breadth of perspectives presented enable readers to get inside some of the great legal minds today, as these experienced lawyers offer up their thoughts around the keys to success within this ever-evolving field.
Author : Robert S. Salcido
Publisher :
ISBN 13 : 9781663338433
Total Pages : 0 pages
Book Rating : 4.3/5 (384 download)
Download or read book False Claims Act & the Healthcare Industry written by Robert S. Salcido and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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 : Linda A. Baumann
Publisher : Bna Books
ISBN 13 : 9781570186622
Total Pages : 913 pages
Book Rating : 4.1/5 (866 download)
Download or read book Health Care Fraud and Abuse written by Linda A. Baumann and published by Bna Books. This book was released on 2007 with total page 913 pages. Available in PDF, EPUB and Kindle. Book excerpt: Baumann (of Arent Fox LLP in Washington, DC) presents a general information reference resource for attorneys working in the field of health law that has been revised so as to be current through May 2007, although some material has been updated past that date in order to cover significant new developments, such as the new Stark III regulations issued in September 2007. Following the introduction, nine chapters address federal physician self-referral restrictions; application of the substantive, qui tam, and voluntary disclosure provisions of the False Claims Act in health care prosecutions; practical considerations for defending health care fraud and abuse cases; legal issues surrounding hospital and physician relationships; risk areas in managed care fraud and abuse for government program participants; corporate compliance programs; potential liabilities for directors and officers of health care organizations; disclosure of qui tam suits and investigations; and control of fraud, waste, and abuse in the Medicare Part D Program.
Author : Aspen Health Law Center
Publisher : Aspen Pub
ISBN 13 : 9780834208995
Total Pages : 388 pages
Book Rating : 4.2/5 (89 download)
Download or read book Health Care Fraud and Abuse Compliance Manual written by Aspen Health Law Center and published by Aspen Pub. This book was released on 1997-01 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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
Author : Kevin J. Darken
Publisher :
ISBN 13 : 9780834211711
Total Pages : 0 pages
Book Rating : 4.2/5 (117 download)
Download or read book Defending and Preventing Health Care Fraud Cases written by Kevin J. Darken and published by . This book was released on 1999 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: It is evident that the federal government is serious about cracking down on health care fraud. This book details how to prevent and defend criminal, civil, and administrative health care fraud investigations. All the key statutes, regulations and cases impacting the field are thoroughly analyzed from the author's unique perspective as both a former federal prosecutor and current white collar criminal defense attorney. This is a reference tool for a primary audience consisting of white collar criminal defense attorneys; attorneys specializing in health care law, particularly Medicare reimbursement, fraud and abuse, or compliance issues; in-house counsel for large to midsize health care corporations (e.g., hospital chains, teaching hospitals, HMOs, DME companies, billing firms, labs); and prosecutors and criminal investigators who want to know what issues defense counsel may raise.
Author : Hoyt W. Torras
Publisher : American Medical Association Press
ISBN 13 :
Total Pages : 452 pages
Book Rating : 4.3/5 (91 download)
Download or read book Health Care Fraud and Abuse written by Hoyt W. Torras and published by American Medical Association Press. This book was released on 2003 with total page 452 pages. Available in PDF, EPUB and Kindle. Book excerpt: A guide for physicians covering the legal aspects of health insurance and offers ways to design an effective billing, coding, and accounts receivable process.
Author : United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations
Publisher :
ISBN 13 :
Total Pages : 224 pages
Book Rating : 4.3/5 (91 download)
Download or read book Health Care Fraud and Waste written by United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Oversight and Investigations and published by . This book was released on 1992 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Kelly M. Pyrek
Publisher : CRC Press
ISBN 13 : 1439820341
Total Pages : 326 pages
Book Rating : 4.4/5 (398 download)
Download or read book Healthcare Crime written by Kelly M. Pyrek and published by CRC Press. This book was released on 2011-01-19 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t
Author : United States
Publisher :
ISBN 13 :
Total Pages : 224 pages
Book Rating : 4.:/5 (327 download)
Download or read book Health Care Fraud and Waste written by United States and published by . This book was released on 1992 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author : Aspen Health Law Center
Publisher :
ISBN 13 :
Total Pages : 156 pages
Book Rating : 4.0/5 ( download)
Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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.
