Health Care Fraud: Enforcement and ComplianceLaw Journal Press, 2023 M12 28 - 1478 pages Health Care Fraud: Enforcement and Compliance is the most complete, essential and up-to-date guide for criminal and civil lawyers, law enforcement officials, health care providers and anyone interested in the health care industry. You'll find discussion of: the latest anti-fraud initiatives from Congress, enforcement agencies and the private bar; advice on criminal law and procedures that health care lawyers cannot afford to ignore; and point-by-point analysis of key decisions, laws and regulations. This deskbook also helps you decide on the right pretrial and trial strategies for clients who have already run afoul of the rules. It features cutting-edge discussions of such topics as: the use of health care fraud laws to enforce clinical care standards; voluntary and involuntary disclosure obligations; expanded treatment of the Federal Anti-kickback Statute--including "Safe Harbor" regulations--and the False Claims Act; proving billing fraud for rendering medically unnecessary services and other fraudulent schemes; obstruction of criminal investigations of health care offenses; and mandatory and permissive exclusion of professionals from health care programs. Health Care Fraud: Enforcement and Compliance also includes detailed coverage of two important areas: compliance issues, including an analysis of Corporate Integrity Agreements; and marketing and pricing fraud in the pharmaceutical industry, including off-label, pricing, Medicaid rebate and kickback concerns. Book ɼ looseleaf, one volume, 1,195 pages; published in 1996, and updated as needed; no additional charge for updates during your subscription. Looseleaf print subscribers receive supplements. The online edition is updated automatically. ISBN: 978-1-58852-073-9 |
Contents
1 | 1-2 |
1 | 1-16 |
05 | 1-26 |
Issues | 2-1 |
CHAPTER 2 | 2-2 |
Privileges in a Corporate Setting 649 | 2-6 |
SelfReferral Statutes | 2-60 |
Research | 2-70 |
828 | 8-28 |
3 Due Diligence in the Selection | 9-24 |
HCPCS Codes 936 | 9-36 |
9 Pharmaceutical Manufacturers 955 | 9-56 |
14 New Locations | 9-64 |
20 Exclusion for Material Breach | 9-64 |
Reimbursement | 10-1 |
b Part B Coverage | 10-6 |
06 | 2-72 |
07 | 2-80 |
Venue | 3-20 |
b Intent | 3-24 |
vi | 3-59 |
x Group Purchasing | 3-65 |
A SurgeonOwned | 3-68 |
04 | 3-68 |
18 U S C 1956 | 3-68 |
18 U S C 1961 et seq 382 | 3-74 |
18 U S C 1347 399 | 3-99 |
CHAPTER 4 | 41 |
b Exceptions for Ownership | 44 |
Deliveries to | 4-16 |
431 | 4-31 |
Relationship | 4-70 |
01A State False Claims Acts 472 4 | 4-70 |
05 | 4-88 |
c Exceptions Relating to Other | 4-107 |
Assistant at Surgery During | 5-2 |
CHAPTER 5 | 5-5 |
Administrative Sanctions | 5-45 |
2 Grounds for Imposing CMP 563 | 5-63 |
4 Procedures Before State Licensing | 5-90 |
Facilities 598 | 5-98 |
CHAPTER 6 | 6-1 |
4 Suppliers of Durable Medical Equipment | 6-4 |
06A Asset Freezes and PreJudgment | 6-30 |
CHAPTER 7 | 7-1 |
7-47 | |
03 | 8-7 |
8 Suspension of Payments Pending | 8-8 |
06 | 8-13 |
07 | 8-15 |
11 | 8-22 |
8 Individual and Small Group Physician | 10-8 |
b Nominal Price Manipulation | 10-36 |
ii | 10-37 |
04 | 10-43 |
Reimbursement 1094 | 10-94 |
0109 | 10-99 |
971 | 10-99 |
034 | 10-99 |
OIG ANTIKICKBACK ADVISORY | 1 |
972 | 2 |
976 | 8 |
036 | 12 |
988 | 19 |
9812 | 19 |
992 | 31 |
993 | 39 |
005 | 62 |
009 | 68 |
0110 | 86 |
0115 | 92 |
9814 | 104 |
025 | 106 |
0011 | 112 |
037 | 127 |
028 | 129 |
998 | 143 |
0412 | 148 |
0101 | 154 |
055 | 162 |
CMS STARK ADVISORY | 1 |
Hospital | 1 |
1 | |
5 | |