AHLA publishes Fraud and Abuse Investigations Handbook for the Health Care Industry, Second Edition. This expanded and updated second edition provides not only the legal context surrounding health care fraud investigations, but also the insight critical to managing the process—and potentially the outcomes that follow. Authors, Paul W. Shaw and Robert A. Griffith, 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.  

This new edition includes four new chapters and updated analysis addressing disclosures of overpayments, Medicare and Medicaid audits and appeals, administrative sanctions, audits by private payers, and the collateral consequences of a health care fraud and abuse investigation. The authors’ explanations are extensively supplemented with 85 sample documents, including indictments, requests for records, subpoenas, internal response memoranda, and responses to auditors, prosecutors, and more. Readers are invited to download 30 of these exhibits and adapt them to suit their own practice and client needs. 

“This book is a true Handbook for anyone who needs to quickly and thoroughly understand the complex nature of a government fraud and abuse investigation,” comments Rob Anderson, AHLA’s Senior Director of Publishing. “The newest edition will provide reliable guidance to health law practitioners as they adapt to critical changes since the first edition and navigate the developments ahead.” 

Fraud and Abuse Investigations Handbook for the Health Care Industry, Second Edition is available to order through AHLA’s store on the LexisNexis website for both members of AHLA and the broader health law professionals' community.  

For a high-resolution image of the book cover, author headshot, or interview inquiries, please contact AHLA. 

About the Authors: 

Paul W. Shaw is a member of the litigation and health law departments of Verrill Dana LLP in Boston, MA, where he concentrates in representing businesses and professionals in health care fraud and abuse investigations. Paul has represented numerous health care clients subject to criminal fraud and abuse and civil false claims act investigations by the federal government and state Medicaid Fraud Control Units. These clients include academic medical centers, pharmaceutical service providers, hospitals, physicians, medical practice groups, behavioral health providers, clinical laboratories, durable medical equipment suppliers, home health agencies and other health care providers. He has also represented The New England Journal of Medicine for many years in connection with litigation involving the Journal. Paul has lectured and written extensively in the area of fraud and abuse before the American Health Law Association, state medical societies, and bar associations. He is Editor-in-Chief of the AHLA publication, Best Practices Handbook for Advising Clients on Fraud and Abuse Issues. He is also co-author of the handbook jointly published by the American Medical Association and AHLA, entitled Avoiding Fraud and Abuse in the Medical Office. Paul is a member of the Editorial Board of the Journal of Health & Life Sciences Law. Paul has been consistently recognized in Chambers USA: America's Leading Lawyers for Business under Healthcare. Paul graduated from Georgetown University Law Center in 1975. 

Robert A. Griffith manages Gargiulo/Rudnick’s health law practice. Bob began his career as an Assistant Attorney General in the Massachusetts Attorney General’s Office assigned to the Medicaid Fraud Control Unit, one of the first such units in the country. Since entering private practice, he has represented hospitals, psychiatric facilities and institutions, physicians, medical group practices, clinical laboratories, pharmaceutical company executives, pharmacies, walk-in centers, nursing homes, durable medical equipment providers, home health agencies, physicians, dentists, nurses, podiatrists, and psychologists. Bob is the author of numerous articles and book chapters on health law topics in the area of fraud and abuse, and a frequent speaker at health law continuing education programs for the legal and medical professions. He has served on the Board of Directors of the American Health Lawyers Association (now American Health Law Association) and the Massachusetts Supreme Judicial Court’s Mental Health Advisors Committee. Bob is a former Chairperson of the Massachusetts Bar Association’s Health Law Section and the Medicine and Law Committee of the Tort and Insurance Practice Section of the American Bar Association. He has participated in over 820 health care fraud and abuse investigations and prosecutions in no fewer than 32 different state and federal jurisdictions and has tried numerous health care fraud and abuse cases on the federal and state level. Mr. Griffith specializes in the representation of health care providers in all matters concerning federal, state, and private fraud and abuse investigations and prosecutions, overpayment demands, billing, compliance, and professional discipline. Bob is a graduate of Boston College Law School.