5 Fraud, Abuse Laws Med Students Should Know

HealthLeadersMedia.com | October 20 – More than half of U.S. medical schools don’t provide any instruction on federal fraud and abuse laws, according to a report from the Office of Inspector General.

That should change, the report said, because Medicare and Medicaid fraud and abuse cost billions each year “and put the programs’ beneficiaries’ health and welfare at risk,” the OIG says.

The OIG highlighted five areas of fraud and abuse law that the office thinks medical students need to learn. They are:

1 The civil False Claims Act, which charges anyone who knowingly submits a fraudulent claim for services to the federal government. Violations generally are punishable by a civil penalty of up to $10,000 an three times the amount of damages suffered by the government.

2. Anti-kickback statute, which imposes felony charges and fines up to $25,000 to anyone “who knowingly and willfully receives or pays anything of value to influence the referral of federal healthcare program business.
Violators also are potentially subject to civil penalties up to $50,000 and prohibited from participating further in federal healthcare programs.

3. Physician self-referral statute, which prohibits the practice of physicians’ referring patients to facilities in which they have ownership or other financial interests, can be punished with civil penalties of $15,000 per improper claim, denial of payment and refunds for certain past claims.

4. The Civil Monetary Penalties Law may result in penalties between $10,000 and $50000 and up to three times the amount unlawfully claimed.

5.  The Exclusion Statute excludes entities or individuals from being reimbursed or participating in Medicare or Medicaid programs for a minimum of three years, depending on the offense, to lifetime exclusion.

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