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

This handbook will arm health care administrators, executives, medical directors, office managers, and physicians, with a broad understanding of Fraud and Abuse enforcements.

Publisher: AHLA

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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