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2nd Edition, 2009 Cumulative Supplement
BNA Books, A Division of Bureau of National Affairs
Supplemental materials are not guaranteed for used textbooks or rentals (access codes, DVDs, workbooks).
Health Care Fraud and Abuse: Practical Perspectives, 2nd Edition, 2009 Cumulative Supplement
by:ABA Health Law Section
The 2009 Cumulative Supplement for HealthCare Fraud and Abuse: Practical Perspectives, Second Edition contains extensive updates including:A new chapter on fraud and abuse in the clinical trial context, covering financial misconduct in clinical research, misconduct in human subject protection, and research misconduct, describing applicable laws,...
The 2009 Cumulative Supplement for HealthCare Fraud and Abuse: Practical Perspectives, Second Edition contains extensive updates including:A new chapter on fraud and abuse in the clinical trial context, covering financial misconduct in clinical research, misconduct in human subject protection, and research misconduct, describing applicable laws, regulations, and other guidance and case law developments, as well as recommendations for compliance.Expanded information on hospital-physician relationships including joint ventures such as whole hospital ventures, ambulatory surgical center (ASC) ventures, under arrangements relationships, physician-hospital organizations, service line leases, acquisition of physician practices and clinical co-management, as well as economic and other credentialing issues such as gainsharing.Detailed analyses of the changes to the Stark regulations implemented in the 2009 Inpatient Prospective Payment System (IPPS) regulations, including the modifications to the critical definition of entity so as to preclude most under arrangements relationships with physician-owned companies, restrictions on the ability to use per click or percentage compensation in certain cases, the newly defined concept of the period of disallowance, and the changes to the stand in the shoes concept, among others.Discussion of Medicare Part D fraud and abuse and the regulations issued to implement the Medicare Improvements for Patients and Providers Act (MIPPA), particularly with regard to marketing and sales agent compensation, payment timelines for pharmacy claims, several key definitions including incurred costs and negotiated prices,as well as descriptions of several recent enforcement initiatives.An examination of several important new cases under the False Claims Act (FCA), such as whether negligence or a false cost report certification necessarily leads to FCA liability, what constitutes reckless disregard and whether the advice of counsel defense always prevents allegations that a party acted in reckless disregard, and the level of direct knowledge a relator must possess to qualify as an original source for purposes of bringing an FCA case.An overview of the wide range of recent fraud and abuse enforcement activity and the issues being reviewed by the OIG in the 2009 Work Plan, including new sections on legislation requiring the disclosure of drug and device vendor relationships, and the 2009 OIG Open Letter to Health Care Providers, which limits the ability of providers to use the OIG s Self Disclosure Protocol in cases solely involving Stark Law violation.The regulations and guidance recently issued concerning marketing rules applicable to managed care organizations, particularly the requirements for agents, brokers, and field marketing organizations.A new section on risk adjustment validation and the increased exposure likely to result from audits that can lead to retroactive payment adjustment or false claims act liability.The Supplemental Compliance Program Guidance for Nursing Facilities and certain recent compliance developments at the state level, including the Massachusetts law requiring the implementation of a marketing code for drug and device manufacturers, and proposed rules that would require certain New York Medicaid providers to adopt a compliance program that meets specified criteria.Coverage of the increased risks of exposure for attorneys, including an insightful discussion of a recent case, Miller v. McDonald, which indicated the possibility of expanded exposure for in-house counsel in connection with corporate fraud, even when perpetrated by others, and recent SEC enforcement action taken against the former general counsel of Tenet, as well as various aspects of the Fraud Enforcement and Recovery Act (FERA), particularly the recent expansion of the FCA.
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