Download or read book AHLA Fraud and Abuse Investigations Handbook for the Healthcare Industry AHLA Members written by and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Download or read book Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2000 with total page 424 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book AHLA Fraud and Abuse Investigations Handbook for 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: Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:Clear and concise explanations of the lawSample government documents, affidavits, and subpoenas accompanying each chapterIllustrative pleadings and memoranda prepared by prosecutors and defense attorneysThe authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:Requests to examine books and records dealing with an organization's programs and operationsInterviews of employees by the OIG or the FBIThe power of HIPAA administrative subpoenas and the broad authority granted under this statuteSteps that should be taken in responding to the government's requestDealing with on-site demands for records and accessInternal audits and investigationsVoluntary disclosuresAffirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Download or read book Ahla Fraud and Abuse Investigations Handbook for the Healthcare Industry written by Robert A. Griffith and published by . This book was released on 2014 with total page 774 pages. Available in PDF, EPUB and Kindle. Book excerpt: If you are not an AHLA member and would like to purchase this title, click here. Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome. This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry- specific area of government enforcement. The resource is complete with: * Clear and concise explanations of the law * Sample government documents, affidavits, and subpoenas accompanying each chapter * Illustrative pleadings and memoranda prepared by prosecutors and defense attorneys The authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of: * Requests to examine books and records dealing with an organization's programs and operations * Interviews of employees by the OIG or the FBI * The power of HIPAA administrative subpoenas and the broad authority granted under this statute * Steps that should be taken in responding to the government's request * Dealing with on-site demands for records and access * Internal audits and investigations * Voluntary disclosures * Affirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution

Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by CRC Press. This book was released on 2017-07-27 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to "detect" healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details n

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 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 Health Care Fraud written by Robert Fabrikant and published by Law Journal Press. This book was released on 2023-12-28 with total page 1308 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Care Fraud: Enforcement and Compliance focuses on fraud and abuse issues involving health care providers as well as application of the laws governing fraud and abuse to manufacturers of drugs and medical devices and other non-providers such as medical researchers.

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 Responding to Health Care Fraud and Abuse Investigations written by Aspatore Books Staff and published by Aspatore Books. This book was released on 2008 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: Responding to Health Care Fraud and Abuse Investigations is an authoritative, insiders perspective on representing and advising health care organizations facing criminal and/or civil fraud and abuse investigations. Featuring partners from some of the nations leading law firms, these experts guide the reader through the different phases of an investigation and the key considerations for each phase. These top lawyers reveal their advice on how to understand the scope allegations, how to develop an initial response, and how to coordinate an internal investigation and evaluate a clients position, including managing documents and communications with knowledgeable individuals at the organization. From weighing self-disclosure and interacting with government agencies to auditing remedial actions and negotiating settlements, these authors outline steps that can be taken to manage liability during the latter stages of an investigation. Additionally, these leaders discuss recent changes in the regulatory landscape, describe the types of actions that often trigger investigations, and offer best practices for mitigating risk through the implementation of effective compliance programs. The different niches represented and the breadth of perspectives presented enable readers to get inside some of the great legal minds today, as these experienced lawyers offer up their thoughts around the keys to success within this ever-evolving field.

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 The NHCAA Fraud Fighter s Handbook written by John Malloy and published by . This book was released on 2007-12 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Health Care Fraud and Abuse Compliance Manual written by and published by Wolters Kluwer Law & Business. This book was released on 1997 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: An immensely practical resource, Health Care Fraud and Abuse Compliance Manual provides a comprehensive overview of legislative and regulatory restrictions that affect the way health care providers conduct business and how they structure relationships among themselves. This treatise helps providers determine the boundaries of permissible conduct under the myriad statutes and regulations that relate to health care fraud and abuse at both the federal and state levels. Specific coverage includes: The statutory language in the Medicare/Medicaid civil money penalties and false claims statutes The Medicare/Medicaid antikickback statute The Stark andquot;self-referralandquot; law The numerous safe harbors and exceptions contained with these prohibitions And more! This authoritative resource will make you aware of your crucial obligations and options. Each chapter of the Health Care Fraud and Abuse Compliance Manual describes what the law requires, how it applies in a health care context, and what the penalties are for failure to comply. With Health Care Fraud and Abuse Compliance Manual: You'll receive coverage of all the critical laws and considerations, including: false claims and fraudulent billings, civil and criminal penalties, the antikickback statute, the safe harbor regulations, the Stark Law, and state statutes You'll get practical advice on developing a corporate compliance program that can help you stay on the right side of the law You'll learn about the structures, goals, and procedures of agencies that investigate health care fraud You'll get an in-depth understanding of what goes into a fraud and abuse investigation - and how you can respond to an investigation to best defend your organization And much, much more! Health Care Fraud and Abuse Compliance Manual has been updated to include: Updated nationwide health care fraud and abuse enforcement statistics OIG Work Plan for FY 12 (Medicaid projects) Enforcement actions involving billing for services of unlicensed personnel Enforcement actions involving billing without proper documentation Enforcement actions involving illegal inducements to beneficiaries Hospital liability for submission of false cost reports Cases involving maximum hospital liability for EMTALA violations Criminal false claims liability for unsolicited telemarketing by a DME supplier Managed care provider liability for cherry-picking, retaining overpayments, and other practices Hospice liability for providing services to ineligible patients Pharmaceutical manufacturer liability for pricing-related false claims violations Enforcement actions involving federal research grant fraud Criminal kickback liability for sham consulting arrangements Self-referral liability for office lease agreements and independent contractor relationships inconsistent with fair market value or not memorialized in writing Updated Medicaid Fraud Control Unit performance standards (MFCU) False claims laws of Massachusetts, Montana, and Nevada OIG evaluation of Massachusetts, Montana, and Nevada false claims laws

Download or read book Health Care Fraud and Abuse written by Linda A. Baumann and published by Bna Books. This book was released on 2007 with total page 913 pages. Available in PDF, EPUB and Kindle. Book excerpt: Baumann (of Arent Fox LLP in Washington, DC) presents a general information reference resource for attorneys working in the field of health law that has been revised so as to be current through May 2007, although some material has been updated past that date in order to cover significant new developments, such as the new Stark III regulations issued in September 2007. Following the introduction, nine chapters address federal physician self-referral restrictions; application of the substantive, qui tam, and voluntary disclosure provisions of the False Claims Act in health care prosecutions; practical considerations for defending health care fraud and abuse cases; legal issues surrounding hospital and physician relationships; risk areas in managed care fraud and abuse for government program participants; corporate compliance programs; potential liabilities for directors and officers of health care organizations; disclosure of qui tam suits and investigations; and control of fraud, waste, and abuse in the Medicare Part D Program.

Download or read book Contract and Procurement Fraud Investigation Guidebook written by Charles E. Piper and published by Routledge. This book was released on 2017-06-26 with total page 188 pages. Available in PDF, EPUB and Kindle. Book excerpt: Contract and procurement fraud, collusion, and corruption are worldwide problems. Such wrongdoing causes federal, state, and local governments, as well as private-sector corporations and businesses, to lose funds and profits, while the wrongdoers unjustly benefit. Bid riggers conspire to eliminate fair and open competition and unjustly increase prices, allowing some to monopolize industries. Too often, contracting officials and others responsible for placing orders or awarding contracts compromise their integrity and eliminate fair and open competition to favor vendors offering bribes or gifts. This results in unfair playing fields for vendors and causes financial losses for businesses, government agencies, and taxpayers. Charles Piper’s Contract and Procurement Fraud and Corruption Investigation Guidebook educates readers on fraud and corruption schemes that occur before, during, and after contracts are awarded. This book teaches not only how to identify such wrongdoing, but also how to investigate it and prevent reoccurrence. Piper shares the Piper Method of Conducting Thorough and Complete Investigations, his innovative and proven method of investigating contract and procurement fraud, and demonstrates its principles with personal, on-the-job examples (which he calls "War Stories") woven throughout the text. Intended for criminal justice students, as well as investigators, auditors, examiners, business owners, policy-makers, and other professionals potentially affected by fraud, this book is a must-read guide to effective procurement and contract fraud investigations from inception to testimony.

Download or read book Defending and Preventing Health Care Fraud Cases written by Kevin J. Darken and published by . This book was released on 1999 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: It is evident that the federal government is serious about cracking down on health care fraud. This book details how to prevent and defend criminal, civil, and administrative health care fraud investigations. All the key statutes, regulations and cases impacting the field are thoroughly analyzed from the author's unique perspective as both a former federal prosecutor and current white collar criminal defense attorney. This is a reference tool for a primary audience consisting of white collar criminal defense attorneys; attorneys specializing in health care law, particularly Medicare reimbursement, fraud and abuse, or compliance issues; in-house counsel for large to midsize health care corporations (e.g., hospital chains, teaching hospitals, HMOs, DME companies, billing firms, labs); and prosecutors and criminal investigators who want to know what issues defense counsel may raise.

Download or read book Healthcare Crime written by Kelly M. Pyrek and published by CRC Press. This book was released on 2011-01-19 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: Crime perpetrated by healthcare professionals is increasingly pervasive in today‘s hospitals and other healthcare settings. Patients, coworkers, and employers are vulnerable to exploitation, fraud, abuse, and even murder. Investigative journalist Kelly M. Pyrek interviews experts who provide accounts concerning the range of criminality lurking in t