Health Care Fraud: Enforcement and Compliance

Front Cover
Law Journal Press, 2021 M07 28 - 1452 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

 

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Contents

1
1-2
18 U S C
1-3
115
1-15
d Inspector General Office of Personnel
1-30
The Problem
2-1
CHAPTER 2
2-2
c Permissive Exclusions 515
2-5
6 Discounts and Rebates
2-6
Courts
6-60
CHAPTER 7
7-1
d Reconciling Sections 3730e4
7-4
717
7-17
21 Appellate Rights
8-21
Is Needed
9-1
f Venue 320
9-3
22 Effect on Successors and Assigns
9-22

7 Monitoring
2-7
13 Reporting Requirements
2-13
540
2-28
e Enforcement
2-50
Research 270
2-70
1 Abuse of Controlled Substances 272 14
2-72
CHAPTER 3
3-1
18 U S C 1956
3-3
a The Elements
3-8
16 OIG Inspection and Audit Rights
3-16
x Group Purchasing
3-65
xvii Cooperative Hospital Service
3-68
18 U S C 1347
3-68
390
3-90
396
3-96
15 Sentencing 3106 2
3-106
v False Certification
41
b Exceptions for Ownership
44
3 Qui Tam Provisions 428
4-28
iii Public Records
4-35
6 AttorneyClient and Work Product
4-70
Relationship
4-70
U S C 666
4-74
CHAPTER 4
4-77
Trigger the Stark Statute 493
4-93
c Exceptions Relating to Other
4-107
xii Medical Staff Incidental
4-116
1 The Changing Economics of American Health
5-1
xviii Billing for Services
5-2
CHAPTER 5
5-5
7 Privileges in Joint Defense
5-7
Civil Monetary Penalties
5-14
xiv Failure to Grant Immediate
5-30
b Medicaid
5-34
1 Intent
5-37
Administrative Sanctions
5-45
553
5-53
03
5-59
2 Grounds for Imposing CMP 563
5-63
p Criminal Acts Involving Federal
5-74
3 NonProcurement Debarment
5-88
4 Procedures Before State Licensing
5-90
Agreements
5-96
1 The Changing Economics of American
6-1
Protections for Medical Records
6-2
18 Disclosure and Privileges
6-18
AttorneyClient and Work Product
6-46
a Integrity of Data Furnished
9-56
Bibliography
9-64
CHAPTER 10
10-1
b Residents Rights 952
10-9
iii Failure to Provide Necessary
10-27
1 Federal Agencies
10-32
1 Inflated AWP or Direct Prices 1032 12
10-32
ii MakingUsing a False
10-44
1 Marketing the Reimbursement
10-52
4 Consulting and Other Personal Service
10-62
b Issues Relating to Other Safe
10-76
9 Value Added Services Including
10-85
12 Charitable Contributions
10-91
TCAi
10-99
992
10-99
005
10-99
0109
10-99
034
10-99
1 Hybrid CivilCriminal Nature
1
8 Individual and Small Group Physician
8
976
19
9812
19
Freedom of Choice
28
b Designation of a Compliance
29
037
32
025
34
993
39
Drugs
50
006
63
038
65
058
69
0010
70
997
76
Reimbursement
84
iii Conspiracy Involving
88
0101
98
981
105
0310
110
0117
120
Public Policy
124
Orthopedics
130
0311
132
Deductibles
166
029
1
e Government Employees as
4
Index
1-1
Copyright

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About the author (2021)

James F. Barger, Jr.

James F. Barger, Jr. is managing partner of Frohsin Barger & Walthall. Mr. Barger has spent much of his career focusing on health care fraud and enforcement through the qui tam provisions of the False Claims Act. Mr. Barger is one of very few attorneys in the country to serve as a private attorney general for the United States in a jury trial as part of a Department of Justice trial team. As long-standing adjunct professor at the University of Alabama School of Law, he teaches an advanced-level course on White Collar investigations - focusing on health care fraud and other fraud enforcement. Mr. Barger regularly publishes in academic law reviews and is regularly featured as a speaker for the American Bar Association, the American Association of Justice, Taxpayers Against Fraud, and the Federal Bar Association.



J. Elliott Walthall

J. Elliott Walthall is managing partner of Frohsin Barger & Walthall. Since 2008, Mr. Walthall has focused his practice almost exclusively on representing whistleblowers in qui tam False Claims Act matters. He has investigated and prosecuted FCA fraud cases in nearly every conceivable context. Under Mr. Walthall's guidance, Frohsin Barger & Walthall has pioneered FCA enforcement in several areas, becoming an undisputed authority on Medicare hospice and home health care fraud in particular and has had an impact on the national dialogue surrounding these patient benefits. Having litigated scores of False Claims Act cases, Mr. Walthall and FBW have successfully obtained awards for whistleblower clients in several high-profile matters.



Elise May Frohsin

Elise May Frohsin serves as an Of Counsel Attorney in the Birmingham, Alabama, office of Frohsin Barger & Walthall. A graduate of Emory Law School, Elise Frohsin has practiced law in Birmingham, Alabama, specializing in the field of commercial litigation and appellate practice, since 1995. Her areas of concentration include complex civil disputes, including representing whistleblowers in multi-state qui tam False Claims Act matters, along with surety and fidelity claims litigation and information technology service and software litigation. She is a member of the Alabama and Georgia Bars.



Benjamin P. Bucy

Benjamin P. Bucy is a graduate of the University of Alabama JD/MBA program and has significant experience in complex litigation, focusing on cases under the qui tam provisions of the False Claims Act. Mr. Bucy is actively involved in investigating and analyzing potential whistleblower actions as well as prosecuting and litigating Frohsin Barger & Walthall's ongoing cases. Accordingly, Mr. Bucy's areas of concentration focus on fraud involving the Medicare hospice benefit, Medicare home health care benefit, the Stark Law and Antikickback Statute, ambulance transport, skilled nursing care, therapy services, medical contracting and durable medical equipment.

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