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Health Care Fraud and Abuse: Practical Perspectives, Third Edition

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Government enforcement against perceived instance of fraud and abuse in the health care industry continues to accelerate and expand into new areas-often leading to record-breaking settlements, sometimes exceeding a billion dollars. Since business practices, well-accepted in other areas, may be investigated as potential crimes in the health care industry, and since there are numerous gray areas in the law, it is difficult to know how to proceed safely.

Health Care Fraud and Abuse: Practical Perspectives, Third Edition, outlines in detail the existing fraud and abuse laws, regulations, case law and other government standards (which lawyers who do not specialize in health law can easily miss) and offers attorneys the practical perspective 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 new 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 new material on:

  • Two key new OIG documents just 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
  • 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 

 


2014 Supplement alone: ISBN 978161746483-6/Order #ABAWEB2483

The 2014 Supplement notes the following issues in one or more chapters:  

  • The increasing number, scope, and scale of fraud and abuse enforcement actions at the federal and state levels, including: a kickback/off-label promotion settlement exceeding $2 billion; Strike Force initiatives; the 2014 OIG Work Plan; the moratorium on home health agency and ambulance supplier enrollment in certain “high risk” areas; and notable defense victories
  • Numerous new sets of rules including the OIG’s proposed regulations related to their civil monetary penalty and exclusion authorities
  • Developments related to the statutory requirement to return overpayments within 60 days of identification and the varying proposed regulations that have been issued to implement it
  • New OIG guidance, including a new Special Fraud Alert and the termination of a previously issued advisory opinion
  • Numerous Part D-related developments including False Claims Act cases and settlements, recent CMS enforcement actions, OIG studies on fraud and abuse related to Part D, and the CMS overutilization monitoring system
  • RAC program amendments and the two-year suspension of appeals

2013/1,272 pp. Hardcover/ABAWEB2301

2014/Approx. 350 pp. Softcover/ABAWEB2483

Main Volume Information

About the Editor-in-Chief
Linda A. Baumann is a partner in Arent Fox, Washington, D.C., where she specializes in health care fraud and abuse and compliance.
ABA Health Law Section