简介
Summary:
Publisher Summary 1
This reference provides experienced practitioners and those new to the field of health care fraud and abuse, with information on structuring acceptable business arrangements, defending clients, and implementing effective corporate compliance programs and other measures to reduce exposure under these complex laws. Some of the topics: the federal physician self-referral restrictions (the Stark Law), False Claims Act jurisprudence, hospital-physician relationships, managed care fraud and abuse risks, effective corporate compliance programs, practical considerations for defending health care fraud cases, and director and officer liabilities. The appendices provide reference materials on the anti-kickback statute, the Stark Law, the civil False Claims Act, the civil monetary penalty and exclusion provisions, private payer fraud, and numerous additional guidance materials including Special Fraud Alerts and Advisory Bulletins, the Self-Disclosure Protocol, and compliance program guidance documents. Supplements are issued annually. Edited by Baumann, member of a health care group in Washington D.C. Annotation c. Book News, Inc., Portland, OR (booknews.com)
目录
Foreword p. vii
Preface p. xi
About the Authors p. xvii
Detailed Table of Contents p. xxv
Chapter 1. An Introduction to Health Care Fraud and Abuse p. 1
Chapter 2. Federal Physician Self-Referral Restrictions p. 45
Chapter 3. The False Claims Act in Health Care Prosecutions: Application of the Substantive, Qui Tam, and Voluntary Disclosure Provisions p. 111
Chapter 4. Practical Considerations for Defending Health Care Fraud and Abuse Cases p. 197
Chapter 5. Legal Issues Surrounding Hospital and Physician Relationships p. 253
Chapter 6. Managed Care Fraud and Abuse: Risk Areas for Government Program Participants p. 307
Chapter 7. Corporate Compliance Programs p. 367
Chapter 8. Potential Liabilities for Directors and Officers of Health Care Organizations p. 403
Appendix List p. 461
Appendix A Anti-Kickback Statute Materials p. 465
Appendix B Stark Self-Referral Law Materials p. 503
Appendix C Civil False Claims Act Materials p. 563
Appendix D Civil Monetary Penalties and Exclusion Materials p. 595
Appendix E Selected Health Care Fraud Statutes Related to Private Payer Fraud p. 679
Appendix F Special Fraud Alerts and Advisory Bulletins p. 687
Appendix G Advisory Opinion Materials: Anti-Kickback Statute and Stark Self-Referral Law p. 691
Appendix H Office of Inspector General Self-Disclosure Protocol p. 693
Appendix I Office of Inspector General Compliance Materials p. 695
Appendix J Medicare Managed Care Materials p. 697
Table of Cases p. 699
Index p. 709
Preface p. xi
About the Authors p. xvii
Detailed Table of Contents p. xxv
Chapter 1. An Introduction to Health Care Fraud and Abuse p. 1
Chapter 2. Federal Physician Self-Referral Restrictions p. 45
Chapter 3. The False Claims Act in Health Care Prosecutions: Application of the Substantive, Qui Tam, and Voluntary Disclosure Provisions p. 111
Chapter 4. Practical Considerations for Defending Health Care Fraud and Abuse Cases p. 197
Chapter 5. Legal Issues Surrounding Hospital and Physician Relationships p. 253
Chapter 6. Managed Care Fraud and Abuse: Risk Areas for Government Program Participants p. 307
Chapter 7. Corporate Compliance Programs p. 367
Chapter 8. Potential Liabilities for Directors and Officers of Health Care Organizations p. 403
Appendix List p. 461
Appendix A Anti-Kickback Statute Materials p. 465
Appendix B Stark Self-Referral Law Materials p. 503
Appendix C Civil False Claims Act Materials p. 563
Appendix D Civil Monetary Penalties and Exclusion Materials p. 595
Appendix E Selected Health Care Fraud Statutes Related to Private Payer Fraud p. 679
Appendix F Special Fraud Alerts and Advisory Bulletins p. 687
Appendix G Advisory Opinion Materials: Anti-Kickback Statute and Stark Self-Referral Law p. 691
Appendix H Office of Inspector General Self-Disclosure Protocol p. 693
Appendix I Office of Inspector General Compliance Materials p. 695
Appendix J Medicare Managed Care Materials p. 697
Table of Cases p. 699
Index p. 709
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