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Interesting and Relevant Articles on Fraud Waste and Abuse

What laws govern CMS fraud, waste, and abuse?

Written by Admin
Posted On January 06, 2024

Federal laws meant to combat Medicare fraud, waste, and abuse are given as follows:

False Claims Act (FCA):

  • Originating from the Civil War era, it protects the federal government, including Medicare, from fraudulent claims.

  • Aims to prevent overcharging and the sale of goods or services below the claimed value.

Anti-Kickback Statute:

  • Prohibits healthcare workers from receiving incentives such as money or goods in exchange for patient referrals or generating business.

Physician Self-Referral Law (Stark Law):

  • Named after Congressman Pete Stark, it prevents physicians from referring patients to healthcare entities in which they or their family members have a financial interest.

Criminal Health Care Fraud Statute:

  • Explicitly prohibits attempts to defraud health benefit programs and obtain money through fraudulent means.

Exclusion Statute:

  • Prevents individuals or entities convicted of health care fraud from participating in federal government-sponsored health care programs.

Civil Monetary Penalties Law:

  • Empowers the federal government to impose monetary penalties on individuals or entities convicted of health care fraud.

These laws collectively form a robust framework aimed at ensuring the integrity of Medicare programs and deterring fraudulent activities within the healthcare system. They play a crucial role in protecting government resources and maintaining the trust and effectiveness of healthcare programs.

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