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AHLA Health Care Compliance Legal Issues Manual (Non-members)

In this reorganized, and expanded edition of AHLA's bestselling, Health Care Compliance Legal Issues Manual, readers will find strategies for addressing the full scope of legal issues critical to health care compliance. The Manual addresses important topics such as what a compliance program is, how to conduct internal investigations, audit basics, what to consider prior to deciding on repayments and disclosures, substantive overviews of the False Claims Act, the Stark and Anti-kickback laws, health information privacy and security, issues in life sciences entities, tax compliance, and many others.

Publisher: AHLA

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Print Book:Softbound, 792 pages
5th Edition
ISBN/ISSN: 9781522173427
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5th Edition
ISBN/ISSN: 9781522173441
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5th Edition
ISBN/ISSN: 9781522173441
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Product description

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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 more
  • Expanded civil monetary penalty and exclusion authorities under 2017 final rules
  • Discussion of core elements of compliance programs for Medicare Advantage Plans and Part D Plans as established by federal regulations
  • Expanded whistleblower protections under federal and state law, false claims based on lack of medical necessity, materiality after Escobar, and recent enforcement activity
  • Expanded discussion of determinations of medical necessity, CMS review of medical necessity terminations, consequences, and appeals processes
  • Recent 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 activity


Brooke Bennet Aziere, Amy Bailey, Douglas A. Blair, Elizabeth Callahan-Morris, Kyle E. Calvin, Elizabeth Carder-Thompson, Ritu Kaur Cooper, Thomas S. Crane, Gerald "Jud" E. DeLoss, Kyle Faget, Emily Black Grey, Gerald M. Griffith, Nancy Bonifant Halstead, Jake Harper, Kenneth E. Hooper, Gabriel L. Imperato, Kevin Kifer, Ronald H. Levine, Melissa L. Markey, Joseph Metro, Macauley Rybar, Alexandra "Allie" B. Shalom, Albert W. Shay, Harry R. Silver, E. John Steren, Drew Stevens, Sarah E. Swank, Teresa A. Williams, Amanda M. Wilwert, Howard J. Young

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Published April, 2019.


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Table of contents

 Chapter 1  Glossary of Key Terms 

Chapter 2  What Is a Compliance Program?

Chapter 3  OIG Model Compliance Guidance by Provider Type

Chapter 4  Background Checks and Excluded Persons

Chapter 5  Government Program Participation and CMS Billing Revocation Authority

Chapter 6  Corporate Transparency and Disclosure

Chapter 7  Regulatory Advice and Liability Issues

Chapter 8  What to Do When the Government Knocks

Chapter 9  Managing an Internal Investigation

Chapter 10  The Relationship between Enforcement and Compliance

Chapter 11  False Claims

Chapter 12  Repayments and Self-Disclosures

Chapter 13  Internal and External Audit Basics

Chapter 14  Medical Necessity, Claims, and Payment Processes

Chapter 15  Stark and Anti-Kickback Prohibitions

Chapter 16  EMTALA Compliance

Chapter 17  Health Care Civil Rights and Nondiscrimination Under Section 1557 of the Affordable Care Act

Chapter 18  Health Information Privacy and Security Laws

Chapter 19  Behavioral Health

Chapter 20  Research Compliance

Chapter 21  Antitrust Laws

Chapter 22  Drugs, Devices, and Life Sciences Entities

Chapter 23  Exempt Organizations and Other Tax Compliance Issues