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Health Care Fraud and Abuse: Practical Perspectives, Third Edition, outlines in detail the existing fraud and abuse laws, regulations, case law, and other government activity, and offers attorneys the practical perspectives and guidance they need to protect their clients. This incomparable treatise offers seasoned counsel, as well as those new to health care law, assistance in structuring acceptable business arrangements, avoiding statutory and regulatory pitfalls, defending clients against government investigations and litigation, implementing effective corporate compliance programs, and more.
The Third Edition has been reorganized to include a separate, comprehensive chapter on the Anti-Kickback Statute, full of practical guidance. The Third Edition also includes material on: two key new OIG documents issued in 2013: the OIG Provider Self-Disclosure Protocol and the OIG Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs (both documents superseding prior guidance on these topics); multiple new settlements and other government enforcement actions and initiatives throughout the health care industry; recent Stark Law developments, including the Tuomey case, one of the few Stark Law cases to go to trial; key developments in the False Claims Act prosecution of off-label marketing cases, (e.g., the Caronia case); increasing enforcement in the Part D arena, including CMS’s concern with preferred networks and other Part D-related issues, as evidenced in multiple OIG audits, Work Plan items, CMPs and False Claims Act cases; and developments indicating potential individual liability, particularly for directors and officers of health care organizations, in areas such as anti-trust and the Foreign Corrupt Practices Act.
The 2017 Cumulative Supplement contains:
The government’s enforcement efforts against individuals and organizations, including increasing use of parallel civil and criminal investigations
Fraud and abuse in managed care, covering new enforcement actions, updated Medicare marketing guidelines, new safe harbors, the pending UnitedHealthcare case on recovering overpayments, and risks from submission of certified data
DOJ guidance on evaluation of corporate compliance programs and guidance from OIG and HCCA on measuring effectiveness
Analysis and practical tips on FCA investigations and litigation, including the public disclosure bar defense, using a Brady disclosure to obtain agency exculpatory evidence, and settling with a relator
Stark law developments, including a new self-referral disclosure protocol, the prohibition against “per unit of service” compensation, and Stark FCA settlements
Notable settlements with medical device manufacturers, pharmaceutical companies, hospitals, and others, government investigation into patient assistance programs, and malpractice lawsuits related to fraud and abuse advice provided
Updated summary charts of OIG Work Plan topics, including twenty-four new topics related to Medicare Parts A and B
New OIG and CMS materials including new regulations, new and revised enrollment moratoria, new advisory opinions and various other types of guidance
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