Health Care Fraud and Abuse: Practical Perspectives, Third Edition

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