This book and CD-ROM package break down the intricacies of the False Claims Act (FCA) and explain how to audit to comply with the FCA. Editor Lawrence W. Vernaglia, JD, MPH, provides strategies to train employees to recognize their roles and responsibilities, and gain additional insight through case studies that demonstrate what the government has done to invoke the FCA to prosecute providers.
With an effective compliance plan in place and diligent staff aware of the Act’s requirements, your facility will have a stronger line of defense that can protect against FCA liability.
Your copy of the Healthcare Compliance Professional’s Guide to the False Claims Act includes a CD-ROM loaded with tools you can download and customize to strengthen your compliance program and prevent fraud and abuse. You will find strategies to help you:
- Distinguish when to report overpayments to fiscal intermediaries or carriers versus when to report to the Office of Inspector General
- Provide employees with FCA compliance training
- Audit FCA compliance, including an audit checklist
- Limit qui tam liability and prevent accusations of retaliation
Also included are case studies that illustrate how and where providers have stumbled in areas including false claims billing, quality of care, and claims for excluded providers. Learn how to benefit from their mistakes and develop procedures that limit your facility’s risk.
Take a look at the Table of Contents
Chapter 1: Implications of the False Claims Act
Chapter 2: Identify risk areas: The rise of quality of care prosecutions
Chapter 3: Staying Out of Trouble: Approaches to Qui Tam Liability
Chapter 4: Implications of the Deficit Reduction Act of 2005 on false claims
Chapter 5: Audit for false claims act compliance
Appendix A: Official text of the False Claims Act
Appendix B: CMS letter: Deficit Reduction Act employee education guidance
Appendix C: Frequently Asked Questions: Deficit Reduction Act employee education guidance
Appendix D: Section 6032 State Plan Preprint
Appendix E: Corporate Compliance Program Effectiveness Assessment
Appendix F: OIG Supplemental Compliance Program Guidance for Hospitals
Appendix G: Publication of OIG’s Guidelines for Evaluating State False Claims Acts
Appendix H: Abbreviations
Meet the Editorial Team
Editor Lawrence Vernaglia, JD, MPH, is a partner with Foley & Lardner, LLP, of Boston, and a member of the firm's Health Care Industry Team. His practice involves regulatory and transactional matters. He runs strategic planning programs for senior management and governing boards. Joining Mr. Vernaglia on this book were Janice A. Anderson, Pamela L. Johnston, C. Elizabeth O'Keeffe, Richard Rifenbark, Lena Robins, R. Michael Scarano, Jr., Anil Shankar, Robert Slavkin, and Judith Waltz, all of Foley & Lardner.
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