AHLA Fraud and Abuse Investigations Handbook for the Health Care Industry, First Edition (AHLA Members)

Robert A. Griffith, Gargiulo/Rudnick LLP; Paul W. Shaw, K&L Gates LLP

Publisher : American Health Lawyers Association

AHLA Fraud and Abuse Investigations Handbook for the Health Care Industry, First Edition (AHLA Members)

Available Formats:

  • Format: Perfect Bound, First Edition, Print Book with CD ISBN: 9780769865720


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  • Format: Electronic book: epub ISBN: 9780769865652


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  • Format: Electronic book: mobi ISBN: 9780769865652


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Table of Contents Author/Contributors
Ch. 1 Introduction
Ch. 2 Overview of Enforcement Agencies
Ch. 3 Statutory Framework for Fraud and Abuse Investigations
Ch. 4 Requests for Information, Investigatory Demands, and Subpoenas
Ch. 5 Responding to Requests for Information
Ch. 6 Handling On-Site Demands for Records and Access
Ch. 7 Retaining Attorneys and Professionals During an Investigation
Ch. 8 The Use of Statistical Sampling During Postpayment Audits
Ch. 9 Internal Audits and Investigations
Ch. 10 Voluntary Disclosures
Ch. 11 Pre-Judgment Asset Seizures and Payment Suspensions
Ch. 12 Criminal and Civil Settlements

About the Author

Robert A. Griffith, Gargiulo/Rudnick LLP and Paul W. Shaw, K&L Gates LLP, authors

Robert Griffith and Paul Shaw are former Assistant Attorney Generals who bring their more than 30 years of experience as private practitioners to bear on the writing of this book. They have represented both businesses and professionals in federal and state, criminal and civil, fraud and abuse investigations.


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Understanding the powers, procedures and remedies available to the government during a health care fraud and abuse investigation, and acquiring a basic understanding of the issues and practical steps to employ during an audit or investigation, are keys to surviving the investigation and achieving a favorable outcome.

This new Handbook will arm health care administrators, executives, medical directors, office managers, physicians, and medical practice managers with a broad understanding of this industry-specific area of government enforcement. The resource is complete with:

• Clear and concise explanations of the law
• Sample government documents, affidavits, and subpoenas accompanying each chapter
• Illustrative pleadings and memoranda prepared by prosecutors and defense attorneys

The authors detail the nuts and bolts of a fraud and abuse investigation, from an overview of the various federal and state enforcement agencies to the potential of settling a case. Learn what to expect and how to respond with coverage of:

• Requests to examine books and records dealing with an organization's programs and operations
• Interviews of employees by the OIG or the FBI
• The power of HIPAA administrative subpoenas and the broad authority granted under this statute
• Steps that should be taken in responding to the government's request
• Dealing with on-site demands for records and access
• Internal audits and investigations
• Voluntary disclosures
• Affirmative actions to try and fend off an investigation, plea agreements, and deferred prosecution