The Law Of Medicare And Medicaid Fraud And Abuse

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ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (137 download)

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Download or read book Health Care Fraud and Abuse Laws Covering Medicare and Medicaid written by and published by . This book was released on 2007 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Based on the fact that the Medicare and Medicaid programs make up the largest single purchaser of health care in the world, and over 20% of all U. S. federal government spending, it is not surprising that these federal health programs have been considered prime targets for fraudulent activity.2 The government has an array of statutes that it may use to combat health care fraud. [...] Other persons involved in connection with the provision of false information to a federal health program may be guilty of a misdemeanor and may be fined up to $10,000 and imprisoned for up to one year.7 One of the most severe sanctions available under the Social Security Act stems from the authority to exclude individuals and entities from participation in federal health care programs.8 Under Sect [...] Exclusion is mandatory for those convicted of certain offenses, including (1) a criminal offense related to the delivery of an item or service under Medicare, Medicaid, or a state health care program; (2) a criminal offense relating to neglect or abuse of patients in connection with the delivery of a health care item or service; or (3) a felony relating to the unlawful manufacture, distribution, p [...] For example, the Ninth Circuit has found that "knowingly and willfully" means that the government must prove that defendants (1) knew their conduct was unlawful (i.e., a violation of the anti-kickback statute) and (2) still engaged in the conduct with the "specific intent" to disobey the law. [...] In its basic application, the Stark law provides that if a physician (or an immediate family member of a physician) has a "financial relationship" with an entity, the physician may not make a referral to the entity for the furnishing of designated health services (DHS)17 for which payment may be made under Medicare or Medicaid.18 A "financial relationship" under the Stark law consists of either (1.