AHLA Legal Issues in Health Care Fraud and Abuse (AHLA Members)
Now includes the 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, 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:
- The Office of Inspector General for the Department of Health and Human Services (HHS-OIG) and the Centers for Medicare & Medicaid Services (CMS) finalized long-awaited additions and revisions to the regulations under the Anti-Kickback Statute (AKS) and physician self-referral law (Stark Law).
- HHS-OIG issued a new revision to the Civil Monetary Penalty regulations.
- HHS-OIG issued numerous advisory opinions in which it permitted a variety of arrangements—and in contrast refused protection in one instance.
- In an effort to lessen health care providers' regulatory burden during the COVID-19 crisis, CMS issued blanket waivers under Section 1135 of the Social Security Act of certain self-referral prohibitions contained in the Stark Law.
- Federal agencies continued to aggressively pursue both individuals and entities in cases involving a wide variety of conduct, while whistleblowers actively pursued those cases in which the government declined to intervene.
This book 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, providing a foundation for working in health law:
- 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 September 2021 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