AHLA Legal Issues in Health Care Fraud and Abuse (AHLA Members)
Now includes the 2024 Cumulative Supplement to the Fifth Edition that provides an update on numerous legal developments under the False Claims Act, including two Supreme Court cases decided in 2023 and an overview of significant settlements of FCA cases.
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Subscribers are advised of the number of Updates that were made to the particular publication the prior year. The number of Updates may vary due to developments in the law and other publishing issues, but subscribers may use this as a rough estimate of future shipments. Subscribers may call Customer Support at 800-833-9844 for additional information.
Subscribers may cancel this subscription by: calling Customer Support at 800-833-9844; emailing customer.support@lexisnexis.com; or returning the invoice marked 'CANCEL'.
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This cumulative supplement provides an update on numerous legal developments under the False Claims Act, including two Supreme Court cases decided in 2023 that addressed the statute’s scienter requirement and the question of when the DOJ can dismiss a case in which it previously declined to intervene.
The supplement also provides an overview of significant settlements of FCA cases and addresses the OIG’s long-promised General Compliance Program Guidance, issued in November 2023, as well as two Special Fraud Alerts since the publication of the Fifth Edition.
Federal agencies have continued to aggressively pursue both individuals and entities for potential violations of fraud and abuse laws, including in connection with COVID-19. In its 2022 "takedowns," for example, the Department of Justice (DOJ) and other collaborative agencies brought COVID-19-related charges against 21 defendants in 9 federal districts relating to an alleged $149 million in false billings, as well as additional fraud charges against 36 defendants in 13 federal districts stemming from an alleged $1.2 billion in fraudulent telemedicine, durable medical equipment, and genetic testing billings.
The DOJ’s subsequent 2023 takedown included charges for performing and billing for expensive tests that were neither ordered or needed in combination with COVID-19 screening tests, billing for COVID-19 over-the-counter tests that Medicare beneficiaries neither wanted nor needed, distributing fake COVID-19 vaccination cards, and fraudulent accepting money under the Provider Relief Fund.
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The 4th Edition ISBN was 9780769854632.
Published September, 2020, soon with August 2024 Cumulative Supplement.
Featured Authors
Laura F. Laemmle-Weidenfeld
Laura Weidenfeld is a partner in the Health Care and Life Sciences practice at Jones Day in Washington DC. Drawing on her extensive experience defending clients against health care fraud enforcement actions, Laura also provides practical compliance advice on Medicare and Medicaid fraud and abuse issues. She defends against numerous investigations and litigation brought by the Department of Justice (DOJ), various U.S. Attorney's offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), state attorneys general, and other state and federal agencies.
Laura also helps her clients navigate challenging compliance issues, including analyzing arrangements under the Stark Law and Anti-Kickback Statute, conducting internal investigations, and preparing self-disclosures.
Earlier in her career, Laura served as a trial attorney in the Frauds Section of the DOJ's Civil Division, where she conducted health care fraud investigations and litigation matters brought under the False Claims Act (FCA) and its whistleblower (or qui tam) provisions.
Laura regularly speaks and writes on health care fraud and abuse issues and has been an active member of the American Health Law Association for over 15 years. She received her JD from Georgetown University Law Center and her BA and BM from Northwestern University.
Table of contents
1 The Fraud Enforcers: Who Are They and What Do They Do?
2 Federal Anti-Kickback Laws
3 Federal Physician Self-Referral Prohibitions
4 Administrative Sanctions Available to Federal Enforcers
5 The False Claims Act and Other Means of Federal Enforcement of Health Care Fraud
and Abuse Laws
6 State and Private Initiatives to Combat Fraud
7 Compliance and Self-Reporting
