Health Care Fraud and Abuse Compliance Manual

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