AHLA Legal Issues in Health Care Fraud and Abuse (AHLA Members)
Now includes the 2022 Cumulative Supplement to the Fifth Edition, prepared in response to the latest and most significant developments in what the government considers to constitute "fraud" or "abuse."
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Since the Fifth Edition of Legal Issues in Health Care Fraud and Abuse was published in early 2020, the government has continued its active regulation and enforcement of fraud and abuse in the health care industry. Federal agencies also continue to aggressively pursue both individuals and entities for potential violations of fraud and abuse laws. This 2022 Cumulative Supplement provides updates on those recent activities, some of which were influenced or driven by the COVID-19 pandemic.
Significant events have occurred in the government's regulation of fraud and abuse in the health care industry—and in its enforcement of those laws and regulations:
- Additions and revisions to the regulations under the Anti-Kickback Statute (AKS) and physician self-referral law (Stark Law)
- Blanket waivers under Section 1135 of the Social Security Act of certain self-referral prohibitions contained in the Stark Law in response to COVID-19
- Numerous advisory opinions, including those addressing preferred hospital networks, joint ventures, per-click referral services, and discounts reflecting services performed by buyers
- Updates on the Special Fraud Alert on speaker programs
- New final rule regarding physician compensation integrity
- Developments regarding the Eliminating Kickbacks in Recovery Act
- Updates on regulation of marketing practices, including United States v. Mallory
- Expansion of the Health Care Fraud Self-Disclosure Protocol to non-providers such as pharmaceutical or medical device manufacturers
- Aggressive pursuit of both individuals and entities in cases involving a wide variety of conduct
- Expanded discussion of exclusion from Medicare, Medicaid, and other programs
- New case law interpreting the False Claims Act and Anti-Kickback Statute
- And much more
With in-depth coverage of the Anti-Kickback Law, Stark Law, False Claims Act, and more, this product is a must-have for anyone who needs to understand the intricacies of how fraud and abuse laws are structured and enforced in the health care context. It also provides essential information for working in health law, such as:
- How health care is regulated in the United States
- How fraud and abuse laws are enforced by federal and state entities
- Practical advice on assessing and addressing risk
- Guidance on navigating relationships with the agencies and individuals enforcing the law's prohibitions
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The 4th Edition ISBN was 9780769854632.
Published September, 2020, with August 2022 Cumulative Supplement.
Table of contents
1 The Fraud Enforcers: Who Are They and What Do They Do?
2 Federal Anti-Kickback Laws
3 Federal Physician Self-Referral Prohibitions
4 Administrative Sanctions Available to Federal Enforcers
5 The False Claims Act and Other Means of Federal Enforcement of Health Care Fraud
and Abuse Laws
6 State and Private Initiatives to Combat Fraud
7 Compliance and Self-Reporting