Fraud and Abuse II

Fraud and Abuse II - Includes • In cash/in kind • Directly/Indirectly • Overt/covert • Giver/Receiver Anti-Kickback Act does not apply to

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False Claims Act: $5,000 - $10,000 per claim + treble damages --> System works very well when there are a FEW very LARGE claims  Ex) Defense contracting (which the idea was originally designed for)   Health care industry = system with LOTS of very SMALL claims that add up quickly Hospitals have no choice but to settle   Corporate Integrity Agreement: Hospital agrees to certain financial controls and agrees to  maintain a  quality  of care  --> Gov doesn't want to pay for sub par care, not really fraud but gov ties it in too   Kickbacks: increase the overall cost of medical care Medicare Anti-Kickback Act : Felony to knowingly and willfully give or receive anything to  induce someone to refer a pt or to buy something for which Medicare/Medicaid may pay.
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Unformatted text preview: Includes: • In cash/in kind • Directly/Indirectly • Overt/covert • Giver/Receiver Anti-Kickback Act: does not apply to bona fide employees Mixed-motives: law says if any part of the motivation was to induce referrals, then it is unlawful ==> "the lust in the heart test" Congress amended the statute to include Safe Harbors: Lists conduct that will be considered ok If you do not fit within safe harbor? Does not = unlawful, goes back to law to determine intent Self Referrals = Stark Law: made it unreasonable for docs to own interest in a hosp (but not unlawful)-> If doc owns interest in a facility, they cannot refer pts to that facility and if they do Medicare/Medicaid cannot be billed for the services provided....
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This note was uploaded on 04/05/2008 for the course HPAA 310 taught by Professor Deanharris during the Fall '07 term at UNC.

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