Fraud includes obtaining a benefit through intentional
misrepresentation or concealment of material facts.
Waste includes incurring unnecessary costs as a result
of deficient management, practices or controls.
Abuse includes any practice that is not consistent
with the goals of providing patients with services that
(1) are medically necessary, (2) meet professionally
recognized standards and (3) are priced fairly.
Fraud, Waste and Abuse Laws
1. The False Claims Act;
2. The Anti-Kickback Statute;
3. The Physician Self-Referral Statute
4. Exclusion Provisions; and
5. The Civil Monetary Penalties Law
Physicians are an important part of protecting the
integrity of the Medicare and Medicaid programs.
The Government needs physicians to understand
the fraud and abuse laws so that you can be partners
in preventing fraud, waste and abuse.
For more information, CLICK HERE for a fact sheet.
The False Claims Act
Prohibits the submission of false or fraudulent claims
to the Government.
Claims may be false if the service is not actually
rendered to the patient, is provided but already
covered under another claim, is miscoded or is not
supported by the medical record.
For False Claims Act violations, you can be fined up to
three times the program's loss, plus $13,946 per claim.
For example: a hospital compensated its physicians
in a way that violated the Stark Law against physician
self-referrals therefore violating the False Claims Act.
The hospital had submitted 21,730 false claims to
Provider Education Training Manual 28
|
