Articles: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-M

Question

Articles: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-Products.pdf

https://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud

Question: According to the FBI, what is the cost of health care fraud? In review of the CMS resource, Medicare Fraud & Abuse, what Federal Laws are in place to prevent fraud? What are key points of the laws? (150 word count)

Articles are properly working I simply copied and pasted each and search them and boom it worked!

Explanation / Answer

Health care fraud costs the country tens of billions of dollars a year. Some patients are also harmed in furtherance of these schemes.

The following Federal fraud and abuse laws apply to physicians:

False Claims Act (FCA)

Anti-Kickback Statute (AKS)

Physician Self-Referral Law (Stark Law)

Social Security Act, which includes the Exclusion Statute and the Civil Monetary Penalties Law (CMPL)

United States Criminal Code

Federal False Claims Act (FCA)

The civil FCA protects the Federal Government from being overcharged or sold substandard goods or services. The FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government.

Anti-Kickback Statute (AKS)

The AKS makes it a crime to knowingly and willfully offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward referrals of items or services reimbursable by a Federal health care program.

Physician Self-Referral Law (Stark Law)

The Physician Self-Referral Law, prohibits a physician from referring for certain designated health services payable by Medicare or Medicaid to an entity where the physician (or an immediate family member) has an ownership/investment interest or a compensation arrangement, unless an exception applies.

Exclusion Statute

Under the Exclusion Statute, the OIG must exclude from participation in all Federal health care programs individuals and entities convicted of medicare fraud

Civil Monetary Penalties Law (CMPL)

The CMPL provides for different amounts of penalties and assessments based on the type of violation.

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