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Health Care Fraud: Enforcement and Compliance

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Health Care Fraud: Enforcement and Compliance focuses on fraud and abuse issues involving health care providers as well as application of the laws governing fraud and abuse to manufacturers of drugs and medical devices and other non-providers such as medical researchers.

Health Care Fraud: Enforcement and Compliance is the most complete, essential and up-to-date guide for criminal and civil lawyers, law enforcement officials, health care providers and anyone interested in the health care industry. You'll find discussion of: the latest anti-fraud initiatives from Congress, enforcement agencies and the private bar; advice on criminal law and procedures that health care lawyers cannot afford to ignore; and point-by-point analysis of key decisions, laws and regulations.

This deskbook also helps you decide on the right pretrial and trial strategies for clients who have already run afoul of the rules. It features cutting-edge discussions of such topics as: the use of health care fraud laws to enforce clinical care standards; voluntary and involuntary disclosure obligations; expanded treatment of the Federal Anti-kickback Statute—including “Safe Harbor” regulations—and the False Claims Act; proving billing fraud for rendering medically unnecessary services and other fraudulent schemes; obstruction of criminal investigations of health care offenses; and mandatory and permissive exclusion of professionals from health care programs.

Health Care Fraud: Enforcement and Compliance also includes detailed coverage of two important areas: compliance issues, including an analysis of Corporate Integrity Agreements; and marketing and pricing fraud in the pharmaceutical industry, including off-label, pricing, Medicaid rebate and kickback concerns.

Book #00636; looseleaf, one volume, 1,195 pages; published in 1996, and updated as needed; no additional charge for updates during your subscription. Looseleaf print subscribers receive supplements. The online edition is updated automatically. ISBN: 978-1-58852-073-9

Additional Information
Division Name LJP
Volumes 1
Product Types Books
Brand LJP
Jurisdiction National
ISBN 978-1-58852-073-9
Page Count 0
Edition 0
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James F. Barger, Jr.

James F. Barger, Jr. holds a juris doctor from the University of Alabama School of Law, a Masters of Arts from the University of Mississippi, and a Bachelors of Arts from Furman University. He is a founding partner of Frohsin Barger & Walthall and has spent much of his career focusing on health care fraud and enforcement through the qui tam provisions of the False Claims Act. Mr. Barger is one of very few attorneys in the country to serve as private attorney general for the United States in a jury trial as part of a Department of Justice trial team. A long-standing adjunct professor at the University of Alabama School of Law, he teaches an advanced-level course on White Collar investigations with a focus on health care and other fraud enforcement. Mr. Barger’s scholarship regarding healthcare fraud has been published in academic law reviews, including the Tulane Law Review and Georgetown University’s American Criminal Law Review, and he is regularly featured as a speaker for national legal organizations such as the American Bar Association, the American Association of Justice, Taxpayers Against Fraud, and the Federal Bar Association and has been quoted as an expert on white collar investigations or had his cases featured in the Washington Post, The New York Times, Huffington Post, NPR, and CNN, among others. Mr. Barger is a member of the United States Supreme Court Bar as well as various federal circuit and district courts throughout the country. 

J. Elliott Walthall

J. Elliott Walthall is a graduate of the University of Alabama School of Law and is managing partner of Frohsin Barger & Walthall. Since 2008, Mr. Walthall has focused his practice almost exclusively on representing whistleblowers in qui tam False Claims Act matters. He has investigated and prosecuted FCA fraud cases across the nation and involving allegations of fraud by U.S. Government contractors in nearly every conceivable context, including the Medicare hospice benefit, the home health care benefit, ambulance transport, skilled nursing care, outpatient therapy services, durable medical equipment, and military contracts. Under Mr. Walthall’s guidance, Frohsin Barger & Walthall has pioneered FCA in enforcement in several of these areas, becoming an undisputed authority on Medicare hospice and home health care fraud in particular and having an impact on the national dialogue surrounding these patient benefits. Having litigated scores of False Claims Act cases, Mr. Walthall and FBW have successfully obtained awards for whistleblower clients in several high-profile matters, including a $5 million settlement with Rural/Metro Ambulance Company; a $24.7 million settlement with SouthernCare Hospice; a $150 million settlement with Amedisys, Inc., and a $75 million settlement with Vitas hospice.

Benjamin P. Bucy

Benjamin P. Bucy is a graduate of the University of Alabama JD/MBA program and has significant experience in complex litigation, focusing on cases under the qui tam provisions of the False Claims Act. Mr. Bucy is actively involved in investigating and analyzing potential whistleblower actions as well as prosecuting and litigating False Claims Act cases. Mr. Bucy’s areas of concentration focus on fraud involving the Medicare hospice benefit, Medicare home health care benefit, the Stark Law and Antikickback Statute, ambulance transport, skilled nursing care, therapy services, medical contracting and durable medical equipment. In the field of international trade law, Mr. Bucy has published “Trade Fraud: The Wild, New Frontier of White Collar Crime,” in the University of Oregon Review of International Law.

Laurence (“Lon”) D. LeSueur, Jr.

Laurence (“Lon”) D. LeSueur, Jr. is a graduate of Louisiana State University’s Paul M. Hebert Law Center, where he received a dual juris doctor and graduate diploma in comparative law. Lon is a former federal law clerk that has deep experience litigating complex disputes, including numerous non-intervened qui tam actions involving false claims and illegal kickbacks. These whisteblower actions concern fraud in relation to the Medicare hospice benefit, the Antikicback Statute, and Stark Law, among others. Lon also has litigated numerous commercial disputes involving hospitals, healthcare providers, insurers, electronic health record software, Medicare/Medicaid billing, HIPAA, and other compliance issues surrounding billing and privacy.

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