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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).

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 ASSN 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.

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 Professionals 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).

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.amaassn.org/ama/pub/physician-resources/legal-topics/regulatory-compliance-topics/health-carefraud-abuse.page.
Federal Bureau of Investigation, Health Care Fraud, http://www.fbi.gov/aboutus/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/.