Prosecuting and Defending Health Care Fraud Cases, Third Edition, With 2018 Cumulative Supplement

This treatise provides transactional lawyers and litigators with full coverage of health care fraud, including the applicable law and the federal criminal process for health care fraud cases. It covers referral restrictions and false claims, transparency requirements for drug and device companies, rules on exclusions and penalties, major fraud settlements, and much more.


Meet The Author


A DEFINITIVE GUIDE to investigations and prosecutions in health care fraud cases 

Prosecuting and Defending Health Care Fraud Cases, Third Edition covers health care fraud from two distinct angles: the applicable law and the federal criminal process for health care fraud cases. This book analyzes trials conducted in a variety of cases, with chapters structured to match the process as it actually takes place during the investigation, after charges are brought, and through sentencing. It presents possible charges, investigative tools, proven trial strategies for both prosecution and defense, considerations for settlement of a prosecution or civil suit, and applicable sentencing factors.

The Third Edition includes: analysis of the U.S. Supreme Court decision in Escobar; a thorough review of the current state of balance between the laws and regulations regarding off-label promotion and the right to free speech set forth in the First Amendment; the addition of “substantial financial hardship” language to the Sentencing Guideline enhancement for multiple victim or mass marketing offenses; discussion of Luis v. United States and the pretrial freezing of a defendant’s assets; and more.




The 2018 Cumulative Supplement includes:


  • Updated cumulative tables of health care fraud settlements exceeding $1 million, including more than 45 settlements of $100 million or more since 2010, as well as analysis of the frequency of settlements and in particular industry segments

  • The civil False Claims Act’s increased mandatory penalties, and decisions on fraudulent inducement, false certification, and the public disclosure bar

  • Updates to the comprehensive examination of virtually every anti-kickback OIG Advisory Opinion issued since 1997, including opinions on provision of discounts and credits to program beneficiaries, reduced-cost lodging and meals to needy patients, and more

  • Instructions to the jury regarding the meaning of the term "induce" and whether the anti-kickback statute requires that the government prove a quid pro quo

  • The tension between the prohibitions on off-label promotion in the Food, Drug, and Cosmetic Act and an individual's First Amendment rights, as applied in a criminal prosecution for violation of the FDCA



Part I. Introduction

Chapter 1. Introduction

Chapter 2. Litigation and Counseling: An Overview

Part II. Theories of Fraud Liability In Health Care Cases

Chapter 3. False Billing Within the Reimbursement Rules of Medicare and Key

Federal Health Care Programs

Chapter 4. The Civil False Claims Act

Chapter 5. The Federal Food, Drug, and Cosmetic Act

Part III. The Anti-Kickback Statute, Stark Prohibitions, and Anti-Kickback

Advisory Opinions

Chapter 6. The Anti-Kickback Statute and Related Safe Harbors

Chapter 7. The Stark Prohibitions and Related Safe Harbors

Chapter 8. The Anti-Kickback Advisory Opinions

Part IV. The Investigation and Charging Decision

Chapter 9. The Investigation

Chapter 10. The Charging Decision

Part V. Settlement and Litigation

Chapter 11. Global Resolutions

Chapter 12. Criminal Trial

Chapter 13. Sentencing

Appendices • Table of Cases • Index


Bloomberg BNA authors and editors are practicing professionals with insider perspectives and real-life experience. Learn more about this book’s authors and editors.
Michael K. Loucks is the former Acting U.S. Attorney and First Assistant U.S. Attorney for the District of Massachusetts. He is now a litigation partner with Skadden Arps, LLP, Boston, MA. 


View full tables of contents and read the book’s preface or introduction.