Health care fraud guide

Phillips & Cohen wrote The Healthcare Provider’s Guide to Whistleblower Lawsuits and the False Claims Act to help health care providers -- who face the potential of false claims liability every day -- as well as their employees better understand the False Claims Act and what happens before and after a whistleblower lawsuit is filed.

The monograph, published in 1997, was written at the request of Washington G-2 Reports, an independent publishing company that specializes in newsletters, reference manuals and other publications for the health care industry.

Below is the table of contents from The Health Care Provider’s Guide to Whistleblower Lawsuits and the False Claims Act. For more information, contact:

Washington G-2 Reports
1111 14^th St NW, Suite 500
Washington, DC 20005-5663
Tel: 800/LAB-REGS (800/522-7347)
Fax: 202/289-4062

The Healthcare Provider’s Guide to Whistleblower Lawsuits and the False Claims Act

Contents

Chapter 1: The False Claims Act & the healthcare industry - - an overview

• Whistleblower lawsuits on the rise
• Health care industry targeted
• Enforcement initiatives escalate
• Whistleblower lawsuits spur other cases
• Criminal penalties for Medicare fraud
• A compliance program well-crafted

  Chapter 2: The False Claims Act: from the Civil War to the Cold War
  

• The Civil War
• 1943 amendments to the act
• 1986 amendments to the act

  Chapter 3: Healthcare providers liability under the False Claims Act
  

• Actions that create liability
  
• Typical violations by healthcare providers
  
• Matters excluded from false claims liability
  
• Matters already the subject of a civil proceeding
  
• Actions based upon matters publicly disclosed
  
• Liability for false claims against the states

  Chapter 4: Qui Tam (whistleblower) provisions of the False Claims Act

• The role of the relator
  
• Shared recovery
  

  Chapter 5: False Claims Act violations
  

• Elements of a cause of action
  
• Kickbacks or false certification may make claims "false"
  
• Statute of limitations
  

  Chapter 6: Penalties and damages under the False Claims Act
  

• Attorneys' fees
  
• Criminal and administrative remedies
  

  Chapter 7: Employment protection for whistleblowers

  Chapter 8: The False Claims Act and other anti-fraud laws
  

• Other federal anti-fraud laws
  
• Alternative administrative remedies
  

  Chapter 9: Avoiding or minimizing False Claims Act liability: corporate compliance programs
  

• Designing an effective compliance program
  
• Reduced penalties
  

  Chapter 10: Voluntary disclosures of Medicare fraud
  

• Voluntary disclosure can reduce liability
• HHS' voluntary disclosure pilot program

  Chapter 11: Anatomy of a False Claims Act case
  

• Procedures for filing a false claims (qui tam) lawsuit
  
• The government's decision to intervene
  
• Final resolution
  
• Terms of settlement
  
• The whistleblower's award
  

  Chapter 12: The False Claims Act and the clinical lab industry
  

• National Health Laboratories Inc.
  
• MetPath, MetWest and Unilab
  
• Damon Clinical Laboratories Inc.
  
• Roche Biomedical Laboratories Inc. and National Health Laboratories Inc. (Laboratory Corp. of America Holdings)
  
• Spectra Laboratories Inc.
  
• SmithKline Beecham Clinical Laboratories Inc.
  
• Hospital outpatient laboratories

  Appendices
  

• The federal False Claims Act
  
• State and District of Columbia false claims statutes
  
• Model compliance program for clinical laboratories, HHS Office of Inspector General
  
• Examples of actual health care fraud schemes
  
• Sample settlement agreement
  
• The PATH (Physicians at Teaching Hospitals) initiative, HHS Office of Inspector General, letter of explanation