Table of Contents
Ch. 1 Introduction
Ch. 2 Overview of Enforcement Agencies
Ch. 3 Statutory Framework for Fraud and
Ch. 4 Requests for Information, Investigatory
Demands, and Subpoenas
Ch. 5 Responding to Requests for Information
Ch. 6 Handling On-Site Demands for Records
Ch. 7 Retaining Attorneys and Professionals
During an Investigation
Ch. 8 The Use of Statistical Sampling During
Ch. 9 Internal Audits and Investigations
Ch. 10 Voluntary Disclosures
Ch. 11 Pre-Judgment Asset Seizures and
Ch. 12 Criminal and Civil Settlements
About the AuthorRobert 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.
If you are not an AHLA member and would like to purchase this title, click here.
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