AHLA Legal Issues in Health Care Fraud and Abuse (AHLA Members)
Now includes the 2023 Cumulative Supplement to the Fifth Edition, prepared in response to the latest and most significant developments in what the government considers to constitute "fraud" or "abuse."
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Since the Fifth Edition of Legal Issues in Health Care Fraud and Abuse was published in 2020, the government has continued to provide further regulation and guidance in the fraud and abuse context, while also continuing to actively enforce health care fraud and abuse laws.
This resource has been updated to include information on those recent activities:
- 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.
- The DOJ has been active in pursuing health care providers and life sciences manufacturers for violations of the civil False Claims Act in cases involving a wide variety of conduct.
- Whistleblowers have been active in bringing cases and, increasingly, pursuing those in which the government declines to intervene.
- The Office of Inspector General for the Department of Health and Human Services (HHS-OIG) and the Centers for Medicare & Medicaid Services finalized additions and revisions to regulations under the Anti-Kickback Statute and Physician Self-Referral Law (also known as the Stark Law).
- The HHS-OIG issued two Special Fraud Alerts, expressing skepticism regarding in-person "speaker programs," and warning health care practitioners of the risks of entering into arrangements with "purported telemedicine companies."
- The HHS-OIG issued numerous advisory opinions to a range of entities, including hospitals, pharmaceutical manufacturers, device manufacturers, and others.
- And much more
These changes and their anticipated impacts are examined in the 2023 Cumulative Supplement to Legal Issues in Health Care Fraud and Abuse, a foundational resource now updated to address recent shifts in the government's approach to regulation and enforcement of health care fraud and abuse.
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The 4th Edition ISBN was 9780769854632.
Published September, 2020, with August 2023 Cumulative Supplement.
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