Health Care Fraud and Abuse

by Baumann, Linda A.; Crane, Thomas S. (CON); Hooper, Patric (CON); Roth, Robert L. (CON); Jones, Nancy S. (CON)

• ISBN13: 9781570181245
• ISBN10: 1570181241
• Edition: CD
• Format: Hardcover
• Copyright: 2002-02-01
• Publisher: Bna Books

Summary

This reference provides experienced practitioners and those new to the field of health care fraud and abuse, with information on structuring acceptable business arrangements, defending clients, and implementing effective corporate compliance programs and other measures to reduce exposure under these complex laws. Some of the topics: the federal physician self-referral restrictions (the Stark Law), False Claims Act jurisprudence, hospital-physician relationships, managed care fraud and abuse risks, effective corporate compliance programs, practical considerations for defending health care fraud cases, and director and officer liabilities. The appendices provide reference materials on the anti-kickback statute, the Stark Law, the civil False Claims Act, the civil monetary penalty and exclusion provisions, private payer fraud, and numerous additional guidance materials including Special Fraud Alerts and Advisory Bulletins, the Self-Disclosure Protocol, and compliance prog

Table of Contents

Foreword	vii
Preface	xi
About the Authors	xvii
Detailed Table of Contents	xxv
An Introduction to Health Care Fraud and Abuse	1	(44)
Federal Physician Self-Referral Restrictions	45	(66)
The False Claims Act in Health Care Prosecutions: Application of the Substantive, Qui Tam, and Voluntary Disclosure Provisions	111	(86)
Practical Considerations for Defending Health Care Fraud and Abuse Cases	197	(56)
Legal Issues Surrounding Hospital and Physician Relationships	253	(54)
Managed Care Fraud and Abuse: Risk Areas for Government Program Participants	307	(60)
Corporate Compliance Programs	367	(36)
Potential Liabilities for Directors and Officers of Health Care Organizations	403	(58)
Appendix List	461	(238)
Appendix A: Anti-Kickback Statute Materials	465	(38)
Appendix B: Stark Self-Referral Law Materials	503	(60)
Appendix C: Civil False Claims Act Materials	563	(32)
Appendix D: Civil Monetary Penalties and Exclusion Materials	595	(84)
Appendix E: Selected Health Care Fraud Statutes Related to Private Payer Fraud	679	(8)
Appendix F: Special Fraud Alerts and Advisory Bulletins	687	(4)
Appendix G: Advisory Opinion Materials: Anti-Kickback Statute and Stark Self-Referral Law	691	(2)
Appendix H: Office of Inspector General Self-Disclosure Protocol	693	(2)
Appendix I: Office of Inspector General Compliance Materials	695	(2)
Appendix J: Medicare Managed Care Materials	697	(2)
Table of Cases	699	(10)
Index	709