Download or read book AHLA False Claims Act The Healthcare Industry Non Members written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Significant events have occurred regarding the government's enforcement and administration of the False Claims Act (FCA) in the last few years. The government has continued to negotiate major settlements against healthcare entities, and the courts have issued numerous decisions that impact the manner in which healthcare businesses are organized and operated. In 2012, the Department of Justice announced that $3 billion of the $5 billion recovered under the FCA was health-related. With these recent developments in FCA litigation and the rapidly developing case law, you will need the Second Edition of False Claims Act & the Healthcare Industry and the 2014 Cumulative SupplementThis authoritative treatise will keep you up-to-date on the latest FCA developments so that you can more effectively advise your client on how to assess their company's potential exposure to liability, evaluate the exposure of companies that they may acquire, and reform company practices to reduce the risk of potential FCA liability.EXPERT ANALYSIS: THE ELEMENTS THAT CREATE LIABILITY UNDER THE FCAWhat does it mean to "Present or Cause to Present" a false claim?How do courts determine whether a claim is "False or Fraudulent"?How does one "know" under the FCA, that a claim is "False"?When is a claim "Material" to the government's determination to pay?LEADING DEFENSES THAT RESULT IN THE DISMISSAL OF QUI TAM ACTIONSWhen are lawsuits barred under the FCA public disclosure bar?What must the whistleblower prove to show that she qualifies as an "original source"?Under what circumstances do courts dismiss actions for failure to state fraud with specificity under Fed.R.Civ.P.9(b)?Under what circumstances does a plaintiff fail to show that defendant submitted a "false" claim or statement under the FCA?Under what circumstances does a plaintiff fail to establish that the defendant "knew" that a claim wa false or fraudulent?FCA DAMAGESHow do courts compute FCA damages in Healthcare upcoding cases and in cases alleging a violation of the FCA because of a violation of the Anti-Kickback or Stark Law?What are the limits courts may impose on the government's or whistleblower's ability to recover FCA damages?FCA STATUTE OF LIMITATIONSHow do courts compute the FCA statute of limitations?VOLUNTARY DISCLOSURES TO THE OIGUnder what circumstances should a company consider submitting a voluntary disclosure?What is the process underlying the submission of a voluntary disclosure?What are the potential benefits and risks associated with submitting a voluntary disclosure?THE FCA WHISTLEBLOWER RETALIATION PROVISIONWhat does a retaliated against "whistleblower" need to prove to obtain damages from the employer?The eBook versions of this title feature links to Lexis Advance for further legal research options.

Download or read book False Claims Act the Healthcare Industry written by Robert S. Salcido and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Significant events have occurred regarding the government's enforcement and administration of the False Claims Act (FCA) in the last few years. The government has continued to negotiate major settlements against healthcare entities, and the courts have issued numerous decisions that impact the manner in which healthcare businesses are organized and operated. In 2012, the Department of Justice announced that $3 billion of the $5 billion recovered under the FCA was health-related. With these recent developments in FCA litigation and the rapidly developing case law, you will need the Second Edition of False Claims Act & the Healthcare Industry and the 2014 Cumulative SupplementThis authoritative treatise will keep you up-to-date on the latest FCA developments so that you can more effectively advise your client on how to assess their company's potential exposure to liability, evaluate the exposure of companies that they may acquire, and reform company practices to reduce the risk of potential FCA liability.EXPERT ANALYSIS: THE ELEMENTS THAT CREATE LIABILITY UNDER THE FCAWhat does it mean to "Present or Cause to Present" a false claim?How do courts determine whether a claim is "False or Fraudulent"?How does one "know" under the FCA, that a claim is "False"?When is a claim "Material" to the government's determination to pay?LEADING DEFENSES THAT RESULT IN THE DISMISSAL OF QUI TAM ACTIONSWhen are lawsuits barred under the FCA public disclosure bar?What must the whistleblower prove to show that she qualifies as an "original source"?Under what circumstances do courts dismiss actions for failure to state fraud with specificity under Fed.R.Civ.P.9(b)?Under what circumstances does a plaintiff fail to show that defendant submitted a "false" claim or statement under the FCA?Under what circumstances does a plaintiff fail to establish that the defendant "knew" that a claim wa false or fraudulent?FCA DAMAGESHow do courts compute FCA damages in Healthcare upcoding cases and in cases alleging a violation of the FCA because of a violation of the Anti-Kickback or Stark Law?What are the limits courts may impose on the government's or whistleblower's ability to recover FCA damages?FCA STATUTE OF LIMITATIONSHow do courts compute the FCA statute of limitations?VOLUNTARY DISCLOSURES TO THE OIGUnder what circumstances should a company consider submitting a voluntary disclosure?What is the process underlying the submission of a voluntary disclosure?What are the potential benefits and risks associated with submitting a voluntary disclosure?THE FCA WHISTLEBLOWER RETALIATION PROVISIONWhat does a retaliated against "whistleblower" need to prove to obtain damages from the employer?The eBook versions of this title feature links to Lexis Advance for further legal research options.

Download or read book False Claims Act and the Healthcare Industry written by Robert Salido and published by . This book was released on 1999 with total page 468 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Antitrust and Health Care written by Christine L. White (Lawyer) and published by . This book was released on 2017 with total page 750 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book False Claims Act the Healthcare Industry written by Robert S. Salcido and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fraud and Abuse Investigations Handbook for the Health Care Industry written by Paul W. Shaw and published by . This book was released on 2021 with total page 775 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.-Preface.

Download or read book Legal Issues in Health Care Fraud and Abuse written by David E. Matyas and published by . This book was released on 2006 with total page 495 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fundamentals of Health Law written by Barry D. Alexander and published by . This book was released on 2011-01-01 with total page 564 pages. Available in PDF, EPUB and Kindle. Book excerpt: This specialized and complex field of health law requires a thorough grounding in the basics, and Fundamentals of Health Law, 5th Edition, provides that grounding like no other book on the market does. This new edition has been thoroughly revised and made current to cover the basic issues of health law practice, from patient to facility issues, from permits and regulation issues to compliance and investigation issues, and includes issues raised by new laws, regulations and guidelines promulgated since the fourth edition in 2008, including the Affordable Care Act (ACA). This publication covers fundamental legal principles and issues to assist: * New Practitioners or experienced attorneys entering their first years of health-law practice; * Professors of health law searching for a comprehensive text for their students; and * Users of any law library looking for answers on the health law resource shelf.

Download or read book AHLA Health Care Compliance Legal Issues Manual Non members written by American Health Lawyers Association and published by . This book was released on 2019 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Authored by experts with years of health care compliance experience, this new edition integrates changes in regulation, trends in enforcement, and the reasoning of the courts to help you navigate emerging and unsettled areas of compliance risk, such as self-disclosure obligations, risks associated with opioid use, and the impact of statistical sampling.Highlights of this edition include:All new glossary of health care compliance terms, including key statutes, acronyms, governing agencies, and moreExpanded civil monetary penalty and exclusion authorities under 2017 final rulesDiscussion of core elements of compliance programs for Medicare Advantage Plans and Part D Plans as established by federal regulationsExpanded whistleblower protections under federal and state law, false claims based on lack of medical necessity, materiality after Escobar, and recent enforcement activityExpanded discussion of determinations of medical necessity, CMS review of medical necessity terminations, consequences, and appeals processesRecent health information privacy and security developments, including new guidance, risks associated with innovative technologies, and trends in Health Insurance Portability and Accountability Act (HIPAA) enforcement activityNew chapters:Chapter 1, Glossary of Key TermsChapter 10, The Relationship between Enforcement and ComplianceChapter 17, Health Care Civil Rights and Nondiscrimination Under Section 1557 of the Affordable Care ActChapter 19, Behavioral Health

Download or read book The Law of Digital Health written by Bernadette M. Broccolo and published by . This book was released on 2018 with total page 253 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Health Care Fraud and Abuse written by Aspen Health Law Center and published by . This book was released on 1998 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

Download or read book AHLA Healthcare Compliance Legal Issues Manual Non Members written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: As the world of health care compliance continues to evolve, so do the potential ramifications for everyone in the healthcare arena. State and federal governmental agencies continue to pursue large recoveries through litigation and settlements against those who don't have effective compliance plans. In fact, the Federal Government announced it had recovered over $4 billion from healthcare providers for Medicare and Medicaid fraud in 2010 alone.This new edition of Health Care Compliance Legal Issues Manual provides a comprehensive overview of the legal issues that create the foundation for healthcare compliance programs, and affect every aspect of these programs. The Manual addresses important topics such as what a compliance program is, how to conduct internal investigations, audit basics, what to consider prior to deciding on repayments and disclosures, substantive overviews of the false claims act, the Stark and Anti-kickback laws, HIPAA privacy and security, issues in life sciences entities, tax compliance, and many othersHighlights of this new edition include:A discussion of the Sunshine Act's reporting requirements for drug and device companiesHHS' Healthy People 2020 initiativeAnalysis of the fraud and abuse provisions in the Patient Protection and Affordable Care Act (ACA)Compliance program requirements for all providers and suppliers as a condition of enrollment in MedicareChanges to the Federal Sentencing GuidelinesNew HIPAA security and privacy enforcement measuresSarbanes-Oxley compliance standards

Download or read book Health Care Transactions Manual written by Kim Harvey Looney and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Pharmaceutical and Medical Device Compliance Manual written by Ela Bochenek and published by . This book was released on 2019 with total page 319 pages. Available in PDF, EPUB and Kindle. Book excerpt: A robust compliance program is essential to protecting a company from running afoul of the myriad laws and regulations that have been enacted to combat fraud and waste. The second edition of the Pharmaceutical and Medical Device Compliance Manual includes guidance to help companies develop a compliance program tailored to today's complex enforcement and business environment. Study of this Manual will enable compliance professionals and lawyers to understand the government's expectations of an effective compliance program and ethical business practices, as well as: how the government discovers potential enforcement actions, its approach to pursuing such actions, what behaviors can constitute mitigating factors for a company in the event of a legal violation. Coverage includes new chapters covering:Pharmaceutical industry interactions with patient organizations Compliance 2.0: compliance analytics in the era of big dataThe art and science of health care compliance in the pharmaceutical and medical device industries The Manual will be a great tool for health and life sciences attorneys, compliance officers, and others in the pharmaceutical and medical devices industry

Download or read book AHLA Pharmaceutical and Medical Device Compliance Manual Non Members written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The fight against fraud and abuse in healthcare programs, and the pharmaceutical and medical devices industry in particular, continues to grow. Since 1996 the federal government has strengthened its efforts to detect and prevent fraud and abuse in healthcare, and has recovered $18 billion since 1997. These enforcement activities make a compliance program essential to protecting a company from running afoul of the myriad laws and regulations that have been enacted to combat fraud and waste. Pharmaceutical and Medical Device Compliance Manual includes guidance to help companies do that.Coverage includes:In-depth coverage of the federal and state enforcement agenciesFederal Anti-Kickback Statute and False Claims Act detailsDistinction between manufacturers' lawful dissemination of scientific information and unlawful promotion of off-label useDiscussion of the Foreign Corrupt Practices Act and its extra-territorial reachCoverage and reimbursement of prescription drugs and medical devicesPrescription drug price regulationsThe Manual includes guidance on building an effective compliance program and will be a great tool for health and life sciences attorneys, compliance officers, and others in the pharmaceutical and medical devices industry.EDITORSKathleen M. Boozang, J.D., LL.M., Professor of Law, SETON HALL LAW, Center for Health & Pharmaceutical Law & Policy, Newark, NJSimone Handler-Hutchinson, J.D., Executive Director, SETON HALL LAW, Center for Health & Pharmaceutical Law & Policy, Newark, NJCONTRIBUTING AUTHORSBret A. Campbell, Esquire; Cadwalader, Wickersham & Taft LLP, Washington, DC; Sujata Dayal, Esquire; Biomet, Inc., Warsaw, IN; Michael Andre Donnella, Esquire; Wyeth, Madison, NJ; Katie Rose Fink, Esquire; U.S. Dept. of Health & Human Services, Office of Inspector General, Washington, DC; Brett R. Friedman, Esquire; Ropes & Gray, LLP, New York. NY; Gary F. Giampetruzzi, Esquire; Pfizer, Inc., New York, NY; Christopher R. Hall, Esquire; Saul Ewing, LLP, Philadelphia, PA; Patrick M. Hromisin, Esquire; Saul Ewing, LLP, Philadelphia, PA; Elizabeth H. Kim, Esquire; Porzio Life Sciences, LLC, Morristown, NJ; Daniel A. Kracov, Esquire; Arnold & Porter, LLP; Washington, DC; Bruce A. Levy, Esquire; Gibbons, PC., Newark, NJ; Ann E. Lewis, Esquire; Ropes & Gray, LLP, New York. NY; Benjamin S. Martin, Esquire; Epstein Becker & Green, PC, Washington, DC; Joseph W. Metro, Esquire; Reed Smith, LLP, Washington, DC; Lewis Morris, Esquire; U.S. Dept. of Health & Human Services, Office of Inspector General, Washington, DC; Kiaema R. Reid; Porzio Life Sciences, LLC, Morristown, NJ; Linda Pissott Reig, Esquire; Buchanan Ingersoll & Rooney, PC, Newark, NJ; Margaret Renner, Esquire; FDA (formerly Arnold & Porter), Silver Spring, MD; Mary Riordan, Esquire; U.S. Dept. of Health & Human Services, Office of Inspector General, Washington, DC; Lynn Shapiro Snyder, Esquire; Epstein Becker & Green, PC, Washington, DC; Brian Tretick; Athena Privacy, LLC, Washington, DC; Robert E. Wanerman, Esquire; Epstein Becker & Green, PC, Washington, DC; and Mara E. Zazzali-Hogan, Esquire, Gibbons, PC., Newark, NJ

Download or read book The Law of American Health Care written by Nicole Huberfeld and published by Aspen Publishing. This book was released on 2018-08-07 with total page 1112 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Law of American Health Care is the casebook for the new generation of health lawyers. It is a student-friendly casebook emphasizing lightly, carefully edited primary source excerpts, plain-language expository text, as well as focused questions for comprehension and problems for application of the concepts taught. The book engages topics in depth so students emerge with an understanding of the most important features of American health care law and hands-on experience working through cutting edge issues. Key Features: Focused on the needs of students who want to practice health care law in a post-ACA world. First health care law casebook to consider federal law as the baseline (as opposed to state law or common law). Intro chapter provides a set of organizing principles, illustrated with in-depth case studies, which are revisited and woven throughout the remaining chapters. “Pop-up” text boxes throughout with notes that highlight key lessons, or help to explain or enhance the material. Directed Questions and hypothetical Problems are provided as well as Capstone Problems at the end of each chapter. Approximately 800 pages, which is significantly more manageable than competitors. Focused directly on topics regularly encountered in the day-to-day practice of health law

Download or read book AHLA Legal Issues in Health Care Fraud and Abuse AHLA Members written by Laura F. Laemmle-Weidenfeld and published by . This book was released on 2020 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This completely updated fifth edition offers broad coverage of the full range of U.S. fraud and abuse prohibitions, with practical application for your work in health care today. Completely updated to address the latest trends in investigation, enforcement, and interpretations of the law, this edition of Legal Issues in Health Care Fraud and Abuse addresses the sweeping changes seen in the health care industry since the previous edition, with over 600 pages of expert explanations and fully referenced real-world examples.With in-depth coverage of the Anti-Kickback Law, Stark Law, False Claims Act, and more, this book is a necessity for anyone who needs to understand the intricacies of how fraud and abuse laws are structured and enforced in the health care context, providing a foundation for your work in health law:How health care is regulated in the United StatesHow fraud and abuse laws are enforced by federal and state entitiesPractical advice on assessing and addressing riskGuidance on navigating relationships with the agencies and individuals enforcing the law's prohibitionsAs health care and society evolve, so too does fraud and abuse law and governmental enforcement activity. Since the previous edition of this book, the risks relating to fraud and abuse have evolved significantly, for reasons ranging from the proliferation of health care data, to the expansion of the use of technology in health care, to changes in the regulatory scheme resulting from the shift toward value-based payment. Every chapter analyzes the impact of these changes.