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What is the Stark law also known as?

The Physician Self-Referral Law, also known as the \u201cStark Law,\u201d generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.

What is False Claim Act in healthcare?

False Claims Act [31 U.S.C. The civil FCA protects the Government from being overcharged or sold shoddy goods or services. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.

Which are examples of major legislation to combat fraud and abuse?

According to the Office of the Inspector General, the five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark Law), the Exclusion Stat- ute, and the Civil Monetary Penalties Law (CMPL).

What is fraud under the False Claims Act?

As discussed above, the FCA requires a defendant to act "knowingly," which includes actual knowledge, deliberate ignorance, or reckless disregard of the truth or falsity of information on which the claim is based (31 U.S.C. § 3729(b)(1)(A)).

What are four examples of commonly encountered health care fraud?

Top 5 Most Common Healthcare Provider Fraud Activities Billing for medically unnecessary services or services not performed. Dig Deeper. ... Falsifying claims or diagnoses. ... Participating in illegal referrals or kickbacks. ... Prescribing unnecessary medications to patients. ... Upcoding for expensive, medically unwarranted services.

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