AHLA Health Care Compliance Legal Issues Manual (AHLA Members)
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As the world of health care compliance continues to evolve, so do the potential ramifications for everyone in the healthcare arena. State and federal governmental agencies continue to pursue large recoveries through litigation and settlements against those who don't have effective compliance plans. In fact, the Federal Government announced it had recovered over $4 billion from healthcare providers for Medicare and Medicaid fraud in 2010 alone. This new edition of Health Care Compliance Legal Issues Manual provides a comprehensive overview of the legal issues that create the foundation for healthcare compliance programs, and affect every aspect of these programs. 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, HIPAA privacy and security, issues in life sciences entities, tax compliance, and many others.
Highlights of this new edition include:
- A discussion of the Sunshine Act's reporting requirements for drug and device companies
- HHS' Healthy People 2020 initiative
- Analysis of the fraud and abuse provisions in the Patient Protection and Affordable Care Act (ACA)
- Compliance program requirements for all providers and suppliers as a condition of enrollment in Medicare
- Changes to the Federal Sentencing Guidelines
- New HIPAA security and privacy enforcement measures
- Sarbanes-Oxley compliance standards
Amy Bailey, Douglas A. Blair, Nancy E. Bonifant, Elizabeth Carder-Thompson, Thomas S. Crane, Gerald "Jud" E. DeLoss, Andrew A. Dick, Gerald M. Griffith, Jacob "Jake" J. Harper, Ann T. Hollenbeck, Kenneth E. Hooper, Gabriel L. Imperato, Richard G. Korman, Ronald H. Levine, Melissa L. Markey, Robert A. Pelaia, Vanessa A. Reynolds, Albert W. Shay, Harry R. Silver, E. John Steren, Jessica M. Warren, Cynthia F. Wisner, and Howard J. Young
Table of Contents
Chapter 1 — The Regulatory Environment
Chapter 2 — What is a Compliance Program?
Chapter 3 — Legal Issues in Operating a Compliance Program
Chapter 4 — Key Medicare/Medicaid Compliance Issues
Chapter 5 — Substantive Overview