What law makes it illegal to submit a falsified bill to a government agency and applies to healthcare because Medicare is a government agency?
The Medicare and Medicaid Patient Protection Act of 1987 is also called the Anti-Kickback Statute (AKBS). This act makes it illegal to give or take kickbacks, bribes, or rebates for healthcare that will be paid for by a government program.
What does the Stark Law prohibit?
The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.Nov 20, 2020
What is the Stark Law in healthcare?
The Stark law prohibits a physician's referral for certain designated healthcare services (DHS) to an entity if the physician (or a member of the physician's immediate family) has a financial relationship with the entity, unless the referral is protected by one or more exceptions provided in the law.
What is an example of a Stark Law violation?
An example of a Stark law violation is a hospital paying doctors money to refer cardiac patients to their hospital. Similarly, it is a violation of Stark for a laboratory or outpatient clinic to pay hospitals to refer patients to them.
What is the False Claims Act in healthcare?
The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded ...
What are Medicare regulations?
Medicare Regulations means, collectively, all federal statutes (whether set forth in Title XVIII of the Social Security Act or elsewhere) affecting Medicare, together with all applicable provisions of all rules, regulations, manuals and orders and administrative, reimbursement and other guidelines having the force of ...
What is DHS under Stark?
The Stark law only applies to “designated health services,” which include many of the ancillary services family physicians provide, such as clinical laboratory services, outpatient prescription drug services and physical and occupational therapy and imaging services (e.g., MRI, CT, ultrasound).
How has the False Claims Act impacted the healthcare sector?
Abstract. A lawsuit under the federal False Claims Act can threaten the survival of a medical practice. The Act prohibits a range of misconduct involving the submission of false claims to the government, as well as the knowing and improper retention of overpayments of government funds.
What is the definition of abuse in Medicare?
Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.
Which of the following actions is considered under the False Claim Act?
Liability under the federal False Claims Act occurs when a defendant (1) knowingly presents (or causes to be presented) a false or fraudulent claim for payment; (2) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim; (3) conspires with others to ...