Sentences with phrase «health care fraud enforcement»

Bloomberg Law introduced Health Care Fraud Analytics, a tool designed to help legal professionals understand trends in health care fraud enforcement, gain context and mitigate risk.

Not exact matches

Recent advances in data analysis technology have given federal controllers, such as the Health Care Fraud Prevention and Enforcement Action Team, new and effective weapons in the fight against fraud, Czarnecki says.

In addition, Mr. Cloherty represents businesses and individuals in enforcement matters and government investigations stemming from health care, securities, and mail and bank fraud allegations.

With extensive knowledge in a variety of white collar defense matters, and an emphasis on health care and securities enforcement, Mateja joins the firm's national White Collar Defense & Government Investigations Practice Group, and will also focus heavily on health care fraud and abuse matters.

Health Law Diagnosis reports and examines issues across a broad array of topics, including fraud and abuse, government enforcement, Medicare and Medicaid, reimbursement, hospitals and health systems, pharmaceuticals, medical devices, and other important areas for the health care and life sciences indusHealth Law Diagnosis reports and examines issues across a broad array of topics, including fraud and abuse, government enforcement, Medicare and Medicaid, reimbursement, hospitals and health systems, pharmaceuticals, medical devices, and other important areas for the health care and life sciences indushealth systems, pharmaceuticals, medical devices, and other important areas for the health care and life sciences indushealth care and life sciences industries.

From health care transactions and regulatory counseling to fraud and abuse investigations, from the defense of government enforcement actions to political advocacy and lobbying, Bryan Cave provides comprehensive and robust solutions to complicated and challenging health care matters.

The commenters identified particular factors that could lead to confusion, including that (1) the phrase «criminal, civil, or administrative proceeding» appeared in the definitions of both law enforcement Start Printed Page 82673and oversight; (2) the examples of oversight agencies listed in the preamble included a number of organizations that also conduct law enforcement activities; (3) the NPRM addressed the issue of disclosures to investigate health care fraud in the law enforcement section (§ 164.510 (f)(5)-RRB-, yet health care fraud investigations are central to the mission of some health care oversight agencies; (4) the NPRM established more stringent rules for disclosure of protected health information pursuant to an administrative subpoena issued for law enforcement than for disclosure pursuant to an oversight agency's administrative subpoena; and (5) the preamble, but not the NPRM regulation text, indicated that agencies conducting both oversight and law enforcement activities would be subject to the oversight requirements when conducting oversight activities.

Because we consider both of these activities to be critical national priorities, we do not require covered entities to obtain authorization for disclosure of protected health information to law enforcement or health oversight agencies — including those oversight activities related to health care fraud.

To clarify further that health oversight disclosure rules apply generally in health care fraud investigations (subject to the exception described above), in the final rule, we eliminate proposed § 164.510 (f)(5)(i), which would have established requirements for disclosure related to health fraud for law enforcement purposes.

We believe that investigations involving health care fraud represent health oversight rather than law enforcement.

In such cases, where the individual is the subject of the investigation and the investigation does not relate to health care fraud, identified as investigations regarding issues (a) through (c), the rules regarding disclosure for law enforcement purposes (see § 164.512 (f)-RRB- apply.

Specifically, this overlap occurred because: (1) The NPRM preamble, but not the NPRM regulation text, indicated that agencies conducting both oversight and law enforcement activities would be subject to the oversight requirements when conducting oversight activities; and (2) the NPRM addressed some disclosures for investigations of health care fraud in the law enforcement paragraph (proposed § 164.510 (f)(5)(i)-RRB-, while health care fraud investigations are central to the purpose of health care oversight agencies (covered under proposed § 164.510 (c)-RRB-.

To clarify further that health oversight disclosure rules apply generally in health care fraud investigations (subject to the exception described above), in the final rule, we eliminate proposed § 164.510 (f)(5)(i), which would have established requirements for disclosure related to health care fraud for law enforcement purposes.

Response: As described above, we clarify the overlap between law enforcement disclosures and health oversight disclosures based on the privacy and liberty interests of the individual (whether the individual also is the subject of the official inquiry) and the nature of the public interest (whether the inquiry relates to health care fraud or to another potential violation of law).

Accordingly, under the final rule, in joint law enforcement / oversight investigations involving suspected health care fraud, the health oversight disclosures apply, even if the individual also is the subject of the investigation.

In the final rule, we include the following as additional examples of health oversight activities: (1) The U.S. Department of Justice's civil rights enforcement activities, and in particular, enforcement of the Civil Rights of Institutionalized Persons Act (42 U.S.C. 1997 - 1997j) and the Americans with Disabilities Act (42 U.S.C. 12101 et seq.), as well as the EEOC's civil rights enforcement activities under titles I and V of the ADA; (2) the FDA's oversight of food, drugs, biologics, devices, and other products pursuant to the Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and the Public Health Service Act (42 U.S.C. 201 et seq.); and (3) data analysis — performed by a public agency or by a person or entity acting under grant of authority from or under contract with a public agency — to detect health care health oversight activities: (1) The U.S. Department of Justice's civil rights enforcement activities, and in particular, enforcement of the Civil Rights of Institutionalized Persons Act (42 U.S.C. 1997 - 1997j) and the Americans with Disabilities Act (42 U.S.C. 12101 et seq.), as well as the EEOC's civil rights enforcement activities under titles I and V of the ADA; (2) the FDA's oversight of food, drugs, biologics, devices, and other products pursuant to the Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) and the Public Health Service Act (42 U.S.C. 201 et seq.); and (3) data analysis — performed by a public agency or by a person or entity acting under grant of authority from or under contract with a public agency — to detect health care Health Service Act (42 U.S.C. 201 et seq.); and (3) data analysis — performed by a public agency or by a person or entity acting under grant of authority from or under contract with a public agency — to detect health care health care fraud.

We eliminate proposed § 164.510 (f)(5)(i) regarding health care fraud from the law enforcement section, because all disclosures that would have been allowed under that provision are allowed under § 164.512 (d) of the final rule (health oversight).