Health Care Fraud and Abuse: Practical Perspectives, Third Edition + 2015 Cumulative Supplement

This treatise offers both health care law practitioners and generalists insights on existing health care fraud and abuse laws, regulations, case law and government standards. Attorneys will find guidance on structuring acceptable business arrangements, avoiding regulatory pitfalls, defending clients against government investigations and litigation, implementing effective corporate compliance programs, and more.

Linda A. Baumann


GET PRACTICAL ASSISTANCE and invaluable insight into this critical area of the law

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.

Supplement Information

The 2015 Cumulative Supplement of Health Care Fraud and Abuse: Practical Perspectives contains:

  • A comprehensive, newly revised chapter on managed care fraud and abuse that highlights key topics including: (i) compliance program requirements, (ii) government review, monitoring and auditing, (iii) enforcement actions, (iv) potential False Claims Act and/or  Anti-Kickback  liability, and (v) prompt payment and denial of care compliance issues in the context of Medicare managed care, Medicaid managed care, Federal Employee Health Benefit Programs and TRICARE;
  • Discussion of the government’s increasing focus on enforcement against individuals, including physicians, for violations of the fraud and abuse laws, as well as a new topic on health care executive liability;
  • Discussion of the rule requiring that overpayments be returned within 60 days, and the first of its kind FCA case, United States v. Continuum Health Partners, Inc. based on an alleged violation of this regulation; 
  • Review of several newly proposed regulations, including those related to the Stark Law, the civil monetary penalty rules and the safe harbors to the anti-kickback statute, including provisions related to gainsharing;
  • Assessment of the numerous new or revised requirements imposed under Part D-related regulations, OIG’s new Supplemental Special Advisory Bulletin on Independent Charity Patient Assistance Programs and various  enforcement initiatives;
  • Analysis of the HHS OIG’s new Practical Guidance for Healthcare Governing Boards on Compliance Oversight;
  • Expanded coverage of health care director and officer liability related to their duty of care, the business judgment rule, potential exposure under the Foreign Corrupt Practices Act as well as increasing scrutiny under the anti-trust laws
  • Discussion of recent cyber attacks against health care organizations and state responses; and
  • Examination of the burgeoning number of multi-million dollar health care fraud abuse cases, including the rare $237 million dollar jury verdict, affirmed by the Fourth Circuit, in the Tuomey Stark/False Claims Act case, and the $850 million DaVita paid to settle FCA cases related to kickbacks and improper billing, including a $450 million settlement paid in a case where the government had declined to intervene.   


Bloomberg BNA authors and editors are practicing professionals with insider perspectives and real-life experience. Learn more about this book’s authors and editors.

Linda A. Baumann is a partner in Arent Fox, Washington, DC, where she specializes in health care fraud and abuse and compliance.

ABA Health Law Section


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