CHAPTER 1: The Regulatory Environment CHAPTER 2: What Is a Compliance Program? CHAPTER 3: Legal Issues in Operating a Compliance Program CHAPTER 4: Key Medicaid Medicare Compliance Issues CHAPTER 5: Substantive Overview
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As the world of healthcare compliance continues to evolve, so do the potential ramifications for everyone in the healthcare arena. State and federal governmental agencies continue to pursue large recoveries through litigation and settlements against those who don't have effective compliance plans. In fact, the Federal Government recently announced it had recovered over $4 billion from healthcare providers for Medicare and Medicaid fraud in 2010 alone.
This new edition of Healthcare Compliance Legal Issues Manual provides a comprehensive overview of the legal issues that create the foundation for healthcare compliance programs, and affect every aspect of these programs. The Manual addresses important topics such as what a compliance program is, how to conduct internal investigations, audit basics, what to consider prior to deciding on repayments and disclosures, substantive overviews of the false claims act, the Stark and Anti-kickback laws, HIPAA privacy and security, issues in life sciences entities, tax compliance, and many others.
Highlights of this new edition include:
• A discussion of the impact of the creation of RACs, ZPICs, and other contractors with audit and enforcement powers
• Overview of the changes to the False Claims Act enacted as part of the Fraud Enforcement and Recovery Act
• Analysis of the fraud and abuse provisions in the Patient Protection and Affordable Care Act (ACA or the Health Reform statute)
• Changes to the Federal Sentencing Guidelines
• New HIPAA security and enforcement measures
• Sarbanes-Oxley compliance standards
• A searchable CD-ROM containing the full text of the Manual with links to selected cases, statutes, and regulations
EDITORS: Harry R. Silver and Cynthia F. Wisner AUTHORS: Amy Bailey-Muckler, Douglas A. Blair, Elizabeth Carder-Thompson, Thomas S. Crane, Gerald "Jud" E. DeLoss, Andrew A. Dick, Gerald M. Griffith, Kenneth E. Hooper, Gabriel L. Imperato, Louise M. Joy, Richard G. Korman, Ronald H. Levine, Melissa L. Markey, Sandra Park, Robert A. Pelaia, Mary Romine, Albert W. Shay, E. John Steren, Paul Sheives, and Howard J. Young