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 Civil False Claims and Qui Tam Actions written by John T. Boese and published by Aspen Publishers. This book was released on 2010-12 with total page 1970 pages. Available in PDF, EPUB and Kindle. Book excerpt: Civil False Claims and Qui Tam Actions is an essential weapon for bringing or defending a qui tam action. This Fourth Edition, two-volume treatise provides comprehensive analysis of The Civil False Claims Statute and a balanced approach to every important aspect of case preparation and litigation -- from establishing the merits of a whistleblower claim to determining the formula for arriving at the qui tam plaintiff's award. Civil False Claims and Qui Tam Actions, frequently cited by the courts, is clearly and concisely written to: walk you, step-by-step, through each phase of case preparation, from the perspective of both plaintiff-relator and whistleblower defendant spell out the unique procedural requirements in a civil false claims action -- from the applicability of statute of limitation rules to the scope of discovery under a andquot;civil investigation demandandquot; by the federal government explain how to draft a whistleblower complaint collect, organize and interpret the controlling case law direct you to the relevant statutory whistleblower provisions, rules and regulations that apply to the issues under discussion analyze the legislative history of The False Claims Act and explains why it is essential to the success of a prosecutor's or defense's cause of action and alert you to emerging trends in civil false claims and qui tam actions For the best guidance on how to bring or defend a qui tam action, consult the civil false claims specialist - John T. Boese. John T. Boese is an expert author and litigation partner in the Washington, DC law office of Fried, Frank, Harris, Shriver andamp; Jacobson. with more than 25 years of experience in civil fraud cases, both as a former DOJ attorney and as defense counsel. In a clear and straightforward manner, he offers his expert analysis of recent developments on: The Supreme Court's decision on andquot;original sourceandquot; in Rockwell The recent trend by state legislatures to enact false claims laws that mirror the federal law. The andquot;presentmentandquot; requirement Corporate liability under The Civil False Claims Act Interpreting the public disclosure bar and original source requirement Challenges to sufficiency of FCA complaints under Rule 9(b) The Civil False Claims Act has captured the attention of any organization doing business with the federal government, for very good reasons: Virtually any person that receives, spends or uses federal money may be liable under The Civil False Claims Act. Private individuals, including employees can be whistleblowers on contractor fraud by bringing a qui tam lawsuit on behalf of the federal government - and receive up to 30% of any judgment or settlement. The courts have upheld highly creative claims brought under The Civil False Claims Act. Don't get lost in the maze of changing, complicated, and confusing qui tam provisions, whistleblower rules, and civil false claims regulations!
Download or read book Whistleblower s Handbook written by Stephen M. Kohn and published by Rowman & Littlefield. This book was released on 2011-03-01 with total page 355 pages. Available in PDF, EPUB and Kindle. Book excerpt: UPDATED IN MARCH 2013 to include the historic $104-million Bradley Birkenfeld whistleblower case and more! From the nation’s leading whistleblower attorney, comes the third edition of the first-ever consumer guide to whistleblowing. In The Whistleblower’s Handbook, Stephen Martin Kohn explains nearly all federal and state laws regarding whistleblowing. In the step-by-step bulk of the book, he also presents twenty-one rules for whistleblowers.
Download or read book The Medical Legal Aspects of Acute Care Medicine written by James E. Szalados and published by Springer Nature. This book was released on 2021-04-02 with total page 694 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Medical-Legal Aspects of Acute Care Medicine: A Resource for Clinicians, Administrators, and Risk Managers is a comprehensive resource intended to provide a state-of-the-art overview of complex ethical, regulatory, and legal issues of importance to clinical healthcare professionals in the area of acute care medicine; including, for example, physicians, advanced practice providers, nurses, pharmacists, social workers, and care managers. In addition, this book also covers key legal and regulatory issues relevant to non-clinicians, such as hospital and practice administrators; department heads, educators, and risk managers. This text reviews traditional and emerging areas of ethical and legal controversies in healthcare such as resuscitation; mass-casualty event response and triage; patient autonomy and shared decision-making; medical research and teaching; ethical and legal issues in the care of the mental health patient; and, medical record documentation and confidentiality. Furthermore, this volume includes chapters dedicated to critically important topics, such as team leadership, the team model of clinical care, drug and device regulation, professional negligence, clinical education, the law of corporations, tele-medicine and e-health, medical errors and the culture of safety, regulatory compliance, the regulation of clinical laboratories, the law of insurance, and a practical overview of claims management and billing. Authored by experts in the field, The Medical-Legal Aspects of Acute Care Medicine: A Resource for Clinicians, Administrators, and Risk Managers is a valuable resource for all clinical and non-clinical healthcare professionals.
Download or read book Dietary Supplements written by United States. Federal Trade Commission. Bureau of Consumer Protection and published by . This book was released on 1998 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Crisis of Conscience written by Tom Mueller and published by . This book was released on 2019 with total page 610 pages. Available in PDF, EPUB and Kindle. Book excerpt: We are living in a time of mind-boggling corruption, but we are also living in a golden age of whistleblowing. Over the past two decades, whistleblowers have emerged as both the government's best weapon against corporate misconduct and the citizenry's best defence against government. Drawing on relentless original research, including in-depth interviews with more than 200 whistleblowers, Crisis of Conscience is a modern-day David-and-Goliath saga, told through a series of riveting cases drawn from Big Pharma, the military, and beyond.
Download or read book Crossing the Global Quality Chasm written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-01-27 with total page 399 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
Download or read book Corruption Crime and Compliance written by Michael Volkov and published by Ethics 360 Media. This book was released on 2011-10 with total page 178 pages. Available in PDF, EPUB and Kindle. Book excerpt: Michael Volkov's career has spanned 30 years as an attorney in Washington, D.C. - as a federal prosecutor, a Chief Counsel on the Senate and House Judiciary Committees, a trial attorney in the Antitrust Division and in private practice. This book will help anyone better understand anti-bribery compliance in the U.S. and beyond. "Michael Volkov's book is a compilation of articles on a number of subjects important to lawyers advising clients how to stay out of trouble. He is a prolific writer and I can say without question, we have not heard the last of his musings. Simply put, his book contains important information that should prove helpful to lawyers, particularly to those who practice in the white collar field." - Judge Stanley Sporkin, Former Director of the Division of Enforcement, U.S. Securities and Exchange Commission.
Download or read book Affordable Excellence written by William A. Haseltine and published by Brookings Institution Press. This book was released on 2013 with total page 198 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Today Singapore ranks sixth in the world in healthcare outcomes well ahead of many developed countries, including the United States. The results are all the more significant as Singapore spends less on healthcare than any other high-income country, both as measured by fraction of the Gross Domestic Product spent on health and by costs per person. Singapore achieves these results at less than one-fourth the cost of healthcare in the United States and about half that of Western European countries. Government leaders, presidents and prime ministers, finance ministers and ministers of health, policymakers in congress and parliament, public health officials responsible for healthcare systems planning, finance and operations, as well as those working on healthcare issues in universities and think-tanks should know how this system works to achieve affordable excellence."--Publisher's website.
Download or read book United States Attorneys Manual written by United States. Department of Justice and published by . This book was released on 1985 with total page 720 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book False Premise False Promise written by Sally C. Pipes and published by Encounter Books. This book was released on 2020-01-07 with total page 121 pages. Available in PDF, EPUB and Kindle. Book excerpt: American health care is at a crossroads. Health spending reached $3.5 trillion in 2017. Yet more than 27 million people remain uninsured. And it's unclear if all that spending is buying higher-quality care. Patients, doctors, insurers, and the government acknowledge that the healthcare status quo is unsustainable. America's last attempt at health reform -- Obamacare -- didn't work. Nearly a decade after its passage in 2010, Democrats are calling for a government takeover of the nation's healthcare system -- Medicare for All. The idea's supporters assert that health care is a right. They promise generous, universal, high-quality care to all Americans, with no referrals, copays, deductibles, or coinsurance. With a sales pitch like that, it's no wonder that seven in ten people now support Medicare for All. Doctors, especially young ones, are coming around to the idea of single-payer, too. Democrats, led by the progressive wing of the party, hope to capitalize on this enthusiasm. In 2017, they introduced companion legislation in the House and Senate that would establish Medicare for All. They have already promised to do the same when the next Congress convenes in 2019. More than 70 House Democrats have joined a new Medicare for All Caucus. Senator Bernie Sanders is effectively already on the presidential campaign trail, making his case for single-payer. If Democrats take the White House and Senate in 2020, and hold onto the House, a Medicare for All bill could be among the first pieces of legislation presented to the new president for a signature. In this book, Sally C. Pipes, a Canadian native, will make the case against Medicare for All. She'll explain why health care is not a right -- and how progressives pressing for single-payer are making a litany of promises they can't possibly keep. Evidence from government-run systems in Canada, the United Kingdom, and other developed countries proves that single-payer forces patients to withstand long waits for poor care at high cost. First, she'll unpack the Medicare for All plans under consideration in Congress. She'll explain how radical they truly are. Medicare for All will not save $5 trillion, as some of its proponents claim. It will cost about $32 trillion over 10 years, according to analyses from the Urban Institute and the Mercatus Center. It will outlaw private health insurance. It will raise taxes by trillions of dollars. It will cut pay for doctors to the rates paid by Medicare and thereby exacerbate our nation's shortage of physicians. And it will ration care. Then, Sally will detail the horrors of single-payer. She'll start in Canada, whose single-payer system most closely resembles the one progressives have in mind for the United States. Analyses of the government-run systems in the United Kingdom and a few other developed countries will follow, with particular focus on the problems that these systems pose for patients and doctors. To substantiate her indictment of single-payer, Sally will marshal both quantitative and qualitative evidence. She'll highlight how Americans fare better than their peers in Canada and the United Kingdom on the health outcomes that are directly linked to the quality of a healthcare system, including survival rates for patients with cancer and cardiovascular issues. She'll also explain why the health outcomes where the United States performs poorly relative to other nations, like infant mortality and life expectancy, tell us little about our healthcare system. Sally will pepper her text with heart-wrenching stories of the human costs of single-payer -- of people who were injured, were forced to remain in pain, or even died because their government-run healthcare system delayed or denied care. Too often, evangelists for free markets limit their arguments to facts and statistics -- and fail to appeal to the public's emotions. Sally will feature the stories of individuals and families who have been victims of single-payer systems. These vignettes will help drive home the truth about single-payer -- and why it must not come to the United States. She'll conclude with her vision for delivering the affordable, accessible, quality care the American people are looking for.
Download or read book License To Steal written by Malcolm K Sparrow and published by Basic Books. This book was released on 2007-12-14 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Download or read book Healthcare Fraud written by Rebecca S. Busch and published by John Wiley & Sons. This book was released on 2012-05-01 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Download or read book Communities in Action written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2017-04-27 with total page 583 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Download or read book False Claims Act the Healthcare Industry written by Robert S. Salcido and published by . This book was released on 2024 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Navigating the U S Health Care System written by Niles and published by Jones & Bartlett Learning. This book was released on 2017-02-15 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt: Navigating the U.S. Health System gives students a solid understanding of the important aspects of the U.S. health system and the role a health navigator plays in the system. Unlike other introductory U.S. Health Care Systems and Delivery texts, Navigating the U.S. Health Care System will include specific strategies on how to be a successful healthcare navigator as well as more detailed information on the delivery of both inpatient and outpatient health care services.
