Legal Aspects of Health Care Reimbursement, written in 1985, presents a historical perspective of reimbursement legislation and regulations with regard to several important aspects of Medicare and Medicaid claims, which have a great potential for fraud and abuse. Focus is on penalties and offenses. Part I deals with Medicare. Several well-documented chapters are dedicated to long-term care, inpatient hospital reimbursement, hospice care, and end-stage renal disease. Part II, deals with Medicaid. In addition to inpatient hospital reimbursement and long-term care, there is an informative expose of abortion and family planning services, to include U.S. Supreme Court cases, legislative restrictions, regulations, and litigation. Each chapter concludes with an "Outlook" section that suggests ways of containing inequities, limiting costs or improving flawed procedures. This impeccably researched study is valuable reading not only for lawyers and health care administrators, but for all health care professionals. Book jacket.

This book provides an overview of the US laws that affect clinical practice for healthcare professionals with no legal background. Divided into thirteen sections, each chapter starts with a summary of the chapter’s content and relevant legal concepts in bullet points before discussing the topics in detail. An application section is provided in many chapters to clarify essential issues by reflecting on clinically relevant case law or clinical vignette(s). Filling a crucial gap in the literature, this comprehensive guide gives healthcare professionals an understanding or a starting point to legal aspects of healthcare.

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.