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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.
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.
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).
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)).
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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Some of the most common types of fraud and abuse are misrepresentation of services with incorrect Current Procedural Terminology (CPT) codes; billing for services not rendered; altering claim forms for higher payments; falsification of information in medical record documents, such as International Classification of ...
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 Authorities, and the Civil Monetary Penalties Law (CMPL).
Examples of Health Insurance Fraud Billing for services never performed. Falsifying a patient's diagnosis to justify the need for tests, surgeries, or other procedures that are not medically necessary. Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic surgery.
Some of the most common types of fraud and abuse are misrepresentation of services with incorrect Current Procedural Terminology (CPT) codes; billing for services not rendered; altering claim forms for higher payments; falsification of information in medical record documents, such as International Classification of ...
Federal Civil False Claims Act (FCA) The civil FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government.

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