The quest to stamp out fraud, waste, and abuse in the nation's health care system has drawn dramatically increased scrutiny of health care billing and reimbursement practices over the years. For those involved in this heavily regulated industry, understanding the powers, procedures, and remedies available to the government during an investigation is paramount. This Second Edition of Fraud and Abuse Investigations Handbook for the Health Care Industryprovides not only the legal context surrounding health care fraud investigations, but also the insight critical to managing the process—and potentially the outcomes that follow.

The American Health Law Association and Authors Paul W. Shaw and Robert A. Griffith have revised this new and necessary Handbook, bringing not only their prior experience as prosecutors, but also decades of experience as private practitioners representing health care businesses and professionals under federal and state criminal and civil fraud and abuse investigations. The Authors examine each stage of a fraud and abuse investigation, beginning with an overview of federal and state enforcement agencies, and concluding with a discussion of the potential collateral consequences of an investigation. They have supplemented their analysis extensively with sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Taken together, the materials in this book provide a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation.

Highlights of the expanded and updated coverage in this new Second Edition include: