Chapter 1 focuses on how the Centers for Medicare and Medicaid Services (CMS) identifies and combats waste, fraud, and abuse in both traditional Medicare and the Medicare Advantage program. Reducing improper payments is critical for protecting the integrity of the program and ensuring that taxpayer dollars are well spent. The Medicaid program, which provides vital health care to over 70 million Americans, regardless of preexisting conditions. GAO and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published reports on continued weaknesses and program integrity risks and Medicaid managed care. Clearly, there is a need for greater transparency on how managed care organizations spend Federal dollars and greater program integrity and oversight in Medicaid in general. Chapter 2 talks about the rate of improper payments in the Medicaid program.

Stepped-up efforts to ferret out health care fraud have put every provider on the alert. The HHS, DOJ, state Medicaid Fraud Control Units, even the FBI is on the case -- and providers are in the hot seat! in this timely volume, you'll learn about the types of provider activities that fall under federal fraud and abuse prohibitions as defined in the Medicaid statute and Stark legislation. And you'll discover what goes into an effective corporate compliance program. With a growing number of restrictions, it's critical to know how you can and cannot conduct business and structure your relationships -- and what the consequences will be if you don't comply.

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.-Preface.