AHLA Health Care Compliance Legal Issues Manual (AHLA 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.
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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.
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