Fraud/Abuse

Question 1

False Claims Act

Answer 1

Protects Federal Government from being overcharged, or sold substandard goods/services
The knowing standard includes acting in deliberate ignorance or reckless disregard of the truth related to the claim

Question 2

Anti-kickback Statute

Answer 2

Criminal offense to knowingly and willingly offer, pay, solicit, or receive bribes or kickbacks to induce or reward referrals in order to induce business reimbursable by a Federal Health Care Program
Ex: cash payment, below fair market value rent

Question 3

Safe Harbors

Answer 3

Not subject to anti-kickback statute because they are unlikely to result in fraud or abuse

Question 4

Physician Self-Referral Law (Stark Law)

Answer 4

Physician referring a pt for a facility in which they have financial interest, be it ownership, investment, family members ownership.
Inherent conflict of interest given the physicians position to benefit from the referral.
May encourage over-utilization of services, in turn driving up health care costs
May create a captive referral system, which limits competition by other providers

Question 5

HIPPA Initial Consent to Treat Applies to

Answer 5

Treatment (day to day documentations and communication)
Health Operations (Q/A, outcomes tracking)
Payment (insurance billing)