AHLA Fraud and Abuse Investigations Handbook for the Health Care Industry, First Edition (Non-Members)

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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 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 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

Authors / Contributors

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