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HEALTH CARE FRAUD

By Cindy Guyer

Articles

Beverly Cohen, Kaboom! The Explosion of Qui Tam False Claims Under the Health Reform

Law, 116 PENN ST. L. REV. 77 (2011).

Richard Doan, The False Claims Act and the Eroding Scienter in Healthcare Fraud Litigation,

20 ANNALS HEALTH L. 49 (2011).

David A. Hyman, Health Care Fraud and Abuse: Market Change, Social Norms, and the Trust

"Reposed in the Workmen," 30 J. LEGAL STUD. 531 (2001).

Aaron S. Kesselheim & David M. Studdert, Whistleblower-Initiated Enforcement Actions

Against Health Care Fraud and Abuse in the United States, 1996 to 2005, 149 ANNALS

INTERNAL MED. 342 (2008).

Joan H. Krause, Following the Money in Health Care Fraud: Reflections on a Modern-Day

Yellow Brick Road, 36 AM. J.L. & MED. 343 (2010).

Joan H. Krause, A Conceptual Model of Health Care Fraud Enforcement, 12 J.L. & POL'Y 55

(2003).

Joan H. Krause, Regulating, Guiding, and Enforcing Health Care Fraud, 60 N.Y.U. ANN. SURV.

AM. L. 241 (2004).

Joan H. Krause, A Patient-Centered Approach to Health Care Fraud Recovery, 96 J. CRIM. L. &

CRIMINOLOGY 579 (2006).

Joan H. Krause, Skilling and the Pursuit of Healthcare Fraud, 66 U. MIAMI L. REV. 363 (2012).

Jing Li et. al., A Survey on Statistical Methods for Health Care Fraud Detection, 11 HEALTH

CARE MGMT. SCI. 275 (2008).

Hanna Lundqvist et al., Health Care Fraud, 49 AM. CRIM. L. REV. 863 (2012).

Yvette M. Mastin, The Punishment of “Health Care Fraud,” 15 J.L. & HEALTH 53 (2000-2001).

Beth C. McClain, Health Care Fraud Enforcement Developments, 2009 WL 4023550

ASPATORE (2009).

Daniel B. McLaughlin, The Challenge of Healthcare Fraud: Supply Chain Structure Could Offer

ACOs a Fraud-Resistant System, 27 HEALTHCARE EXEC. 60 (2012).

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Modern Healthcare, Largest Healthcare Fraud Settlements. Ranked by Amount Recovered Under

the False Claims Act in 2011, 42 MODERN HEALTHCARE 32 (2012).

Kevin Outterson, Punishing Health Care Fraud---Is the GSK Settlement Sufficient?, 367 NEW

ENG. J. MED. 1082 (2012).

Marilyn Price & Donna M. Norris, Health Care Fraud: Physicians as White Collar Criminals?,

37 J. AM. ACAD. PSYCHIATRY & L. 286 (2009).

Arti K. Rai, Health Care Fraud and Abuse: A Tale of Behavior Induced by Payment Structure,

30 J. LEGAL STUD. 579 (2001).

William J. Rudman et. al., Healthcare Fraud and Abuse, PERSPS. HEALTH INFO. MGMT (Sept. 16,

2009), available at http://perspectives.ahima.org/healthcare-fraud-and-abuse/#.UUjZYhfU8a8.

Elizabeth R. Sheyn, Toward A Specific Intent Requirement in White Collar Crime Statutes: How

the Patient Protection and Affordable Care Act of 2010 Sheds Light on the "General Intent

Revolution," 64 FLA. L. REV. 449 (2012).

Donald W. Simborg, Healthcare Fraud: Whose Problem is it Anyway?, 15 J. AM. MED.

INFORMATICS ASS’N 278 (2008).

Monographs and Reports

E. BART DANIEL ET AL., HEALTH CARE FRAUD AND COLLATERAL CONSEQUENCES (2d ed. 2011).

JAMES KARAS ET AL., RESPONDING TO HEALTH CARE FRAUD AND ABUSE INVESTIGATIONS:

LEADING LAWYERS ON RESPONDING TO INITIAL ALLEGATIONS MINIMIZING EXPOSURE, AND

NEGOTIATING SETTLEMENTS (2008).

TERRY L. LEAP, PHANTOM BILLING, FAKE PRESCRIPTIONS, AND THE HIGH COST OF MEDICINE:

HEALTH CARE FRAUD AND WHAT TO DO ABOUT IT (2011).

Jennifer Staman, Congressional Research Service, THE FALSE CLAIMS ACT, THE ALLISON

ENGINE DECISION, AND POSSIBLE EFFECTS ON HEALTH CARE FRAUD ENFORCEMENT (Nov. 6,

2008), available at http://d1lj51l9p3qzy9.cloudfront.net/handle/10207/bitstreams/19370.pdf.

U.S. Department of Health & Human Services and the Department of Justice. HEALTH CARE

FRAUD AND ABUSE CONTROL PROGRAM – ANNUAL REPORT FOR FISCAL YEAR 2012 (February

2013), available at https://oig.hhs.gov/reports-and-publications/hcfac/index.asp.

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Practice Materials

LINDA A. BAUMANN, HEALTH CARE FRAUD & ABUSE: PRACTICAL PERSPECTIVES (2d ed. 2007

with 2012 supplement).

SCOTT BECKER, HEALTH CARE LAW: A PRACTICAL GUIDE (2012).

BLOOMBERG BNA, HEALTH LAW RESOURCE CENTER (including the Health Care Fraud Report

and Fraud, Abuse & Compliance).

Portfolio 1500: Federal Anti-Kickback Law

Portfolio 2400: Federal Self-Referral Law

Portfolio 2600: Health Care Fraud and Abuse: Enforcement and Compliance

Portfolio 2650: False Claims Act: Health Care Applications and Defenses

REBECCA S. BUSCH, HEALTHCARE FRAUD: AUDITING AND DETECTION GUIDE (2012).

PAUL CACIOPPO, HEALTH CARE FRAUD & ABUSE: A GUIDE TO FEDERAL SANCTIONS (2012).

CCH, INC., HEALTH CARE COMPLIANCE PORTFOLIO (including the Health Care Compliance

Newsletter, Health Care Compliance Professional’s Manual, and Health Care Compliance

Reporter).

ALICE G. GOSFIELD, MEDICARE AND MEDICAID FRAUD AND ABUSE (2012).

ALICE G. GOSFIELD, HEALTH LAW HANDBOOK (2012).

HEALTH CARE LAWYERS OF GREAT LAKES LAW, CARBIS WALKER & ASSOCIATES, AND VON

BRIESEN & ROPER, HEALTH CARE LAW COMPLIANCE MANUAL (2012).

MICHAEL K. LOUCKS & CAROL C. LAM, PROSECUTING AND DEFENDING HEALTH CARE FRAUD

CASES (2d ed. 2011).

DAVID E. MATYAS & CARRIE VALIANT, LEGAL ISSUES IN HEALTH CARE FRAUD AND ABUSE:

NAVIGATING THE UNCERTAINTIES (4th

ed. 2012).

CLAIRE SYLVIA, FALSE CLAIMS ACT: FRAUD AGAINST THE GOVERNMENT (2d ed. 2010-2012).

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Websites

American Bar Association, Directory of Health Law Blogs,

http://www.abajournal.com/blawgs/topic/health+law/.

American Medical Association, Resources – Health Care Fraud Abuse, http://www.ama-

assn.org/ama/pub/physician-resources/legal-topics/regulatory-compliance-topics/health-care-

fraud-abuse.page.

Federal Bureau of Investigation, Health Care Fraud, http://www.fbi.gov/about-

us/investigate/white_collar/health-care-fraud.

Dan Hargrove, Govt Fraud Lawyer, http://govtfraudlawyer.blogspot.com/.

David Harlow, Health Care Blog – HealthBlawg, http://healthblawg.typepad.com/.

National Health Care Anti-Fraud Association, http://www.nhcaa.org/.

Office of the Inspector General, U.S. Department of Health & Human Services,

https://oig.hhs.gov/.

U.S. Department of Health & Human Services and U.S. Department of Justice, STOP Medicare

Fraud, http://www.stopmedicarefraud.gov/.