AHLA Fraud and Abuse Investigations Handbook for the Health Care Industry (AHLA Members)
This handbook will arm health care administrators, executives, medical directors, office managers, and physicians, with a broad understanding of Fraud and Abuse enforcements.
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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 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 law
- Sample government documents, affidavits, and subpoenas accompanying each chapter
- Illustrative pleadings and memoranda prepared by prosecutors and defense attorneys
The 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 operations
- Interviews of employees by the OIG or the FBI
- The power of HIPAA administrative subpoenas and the broad authority granted under this statute
- Steps that should be taken in responding to the government's request
- Dealing with on-site demands for records and access
- Internal audits and investigations
- Voluntary disclosures
- Affirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution
Published January, 2014.
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Table of Contents
Ch. 1 Introduction
Ch. 2 Overview of Enforcement Agencies
Ch. 3 Statutory Framework for Fraud and Abuse Investigations
Ch. 4 Requests for Information, Investigatory Demands, and Subpoenas
Ch. 5 Responding to Requests for Information
Ch. 6 Handling On-Site Demands for Records and Access
Ch. 7 Retaining Attorneys and Professionals During an Investigation
Ch. 8 The Use of Statistical Sampling During Postpayment Audits
Ch. 9 Internal Audits and Investigations
Ch. 10 Voluntary Disclosures
Ch. 11 Pre-Judgment Asset Seizures and Payment Suspensions
Ch. 12 Criminal and Civil Settlements