Health Care Fraud: Enforcement and Compliance

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Law Journal Press, Jul 28, 2016 - Law - 525 pages
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Health Care Fraud: Enforcement and Compliance is the most complete, essential and up-to-date guide for criminal and civil lawyers, law enforcement officials, health care providers and anyone interested in the health care industry. You'll find discussion of: the latest anti-fraud initiatives from Congress, enforcement agencies and the private bar; advice on criminal law and procedures that health care lawyers cannot afford to ignore; and point-by-point analysis of key decisions, laws and regulations.

This deskbook also helps you decide on the right pretrial and trial strategies for clients who have already run afoul of the rules. It features cutting-edge discussions of such topics as: the use of health care fraud laws to enforce clinical care standards; voluntary and involuntary disclosure obligations; expanded treatment of the Federal Anti-kickback Statute--including "Safe Harbor" regulations--and the False Claims Act; proving billing fraud for rendering medically unnecessary services and other fraudulent schemes; obstruction of criminal investigations of health care offenses; and mandatory and permissive exclusion of professionals from health care programs.

Health Care Fraud: Enforcement and Compliance also includes detailed coverage of two important areas: compliance issues, including an analysis of Corporate Integrity Agreements; and marketing and pricing fraud in the pharmaceutical industry, including off-label, pricing, Medicaid rebate and kickback concerns.
 
 

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Contents

CHAPTER 1
2-1
CHAPTER 2
2-2
18 U S C
2-3
CHAPTER 9
2-54
CHAPTER 3
3-1
xiv Practitioner Recruitment
3-2
CHAPTER 4
4-1
c Permissive Exclusions 515
4-5
036
A-12
024
A-20
989
A-22
9813
A-28
993
A-39
005
A-62
009
A-68
0110
A-86

3 Qui Tarn Provisions 428
4-28
CHAPTER 5
5-1
CHAPTER 6
6-1
06A Asset Freezes and PreJudgment
6-30
Provider 115
7-1
Care Fraud
8-2
e Government Employees as
8-4
Is Needed
9-1
2 Clinical Laboratories 934
9-34
10 Supplemental Compliance Program
9-60
CHAPTER 10
10-1
f Venue 320
10-3
1 Federal Agencies
10-38
Reimbursement 1094
10-116
972
10-128
035
10-140
973
A-3
OIG ANTIKICKBACK ADVISORY
A-9
047
A-87
0115
A-92
9814
A-104
025
A-106
0011
A-112
0117
A-120
037
A-127
998
A-143
048
A-144
0101
A-154
056
A-162
CMS STARK ADVISORY
A-169
fiii Failure to Provide Necessary
TU-1
Index
1-1
0210
1-5
0311
1-9
CoPayments
1-17
Copyright

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About the author (2016)

Robert Fabrikant is a partner in the Washington, D.C. office of Manatt, Phelps & Phillips, LLP, and is the Distinguished Practitioner-in-Residence at Howard University School of Law. Following law school, Mr. Fabrikant was the Senior Law Clerk to Chief Justice Warren E. Burger. Since 1982, Mr. Fabrikant has been a trial lawyer focusing on complex civil and criminal litigation in the health care industry, with an emphasis on antitrust, RICO, False Claims Act, and other fraud and abuse issues. Prior to entering private practice, Mr. Fabrikant was Assistant Chief of the Energy Section, Antitrust Division, U.S. Department of Justice; an Assistant U.S. Attorney for the District of Columbia; and a Faculty Member, University of Singapore Law School; Counsel, Monetary Authority of Singapore. He is a member of the New Jersey, District of Columbia and California Bars and the American Bar Association, where he has founded and headed subcommittees on health care fraud and abuse and the False Claims Act and qui tam issues. Mr. Fabrikant is the author of numerous articles on fraud and abuse issues in the health care area and the False Claims Act.

Paul E. Kalb, M.D., is a partner in the Washington D.C. office of Sidley Austin LLP where he co-heads the firm s Global Life Sciences practice and heads the firm's national health care practice. He principally represents health care providers and pharmaceutical and medical device manufacturers in criminal, civil and administrative litigation and enforcement actions arising under the various health care fraud statutes. His practice includes both general and appellate (including Supreme Court) litigation. He is the author of numerous articles in both legal and medical literature. He is Board-certified in Internal Medicine and a graduate of Yale Law School. He is a member of the District of Columbia State Bar and the American Bar Association.

Pamela H. Bucy is the Bainbridge Professor of Law at the University of Alabama School of Law. Prior to entering teaching, she served as an Assistant United States Attorney, Criminal Division, E.D. Missouri. In this capacity, Professor Bucy prosecuted white collar crimes, including health care fraud. She also established and served as the first coordinator of a health care fraud task force comprised of attorneys and investigators from federal, state and private offices. Professor Bucy has written extensively in the area of health care fraud and white collar crime, including a casebook used in law schools around the country. Professor Bucy is a member of the American Bar Association and the Alabama and Missouri Bars. She has served on many ABA and state and local bar committees and has served as Co-chair of the ABA subcommittee on Health Care Fraud.

Mark D. Hopson is a partner in the Washington D.C. office of Sidley Austin LLP and a co-chair of the firm's national White Collar and Internal Investigation practice. His practice involves complex civil and criminal trial litigation, as well as the conduct of internal investigations and compliance-related counseling. He has substantial experience in the representation of health care providers and consultants in connection with criminal and civil investigations and litigation, particularly with respect to claims under the False Claims Act. Mr. Hopson has written numerous articles and participates often in conferences on white collar crime and health care. He is a member of the District of Columbia Bar and the American Bar Association.

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