Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. The 3 major laws that protect against healthcare fraud are the Anti-kickback statute, Stark, and the False Claims Act. From the readings and independent research, find one (1) specific real life legal case example of how kickback arrangements would violate the Stark Law. In addition, discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. From the readings and independent research, find one (1) specific real life legal case example of a breach of the False Claims Act by a health-related organization. In addition, discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not?
Read the background articles. This discussion requires research beyond the articles. See Discussion Expectations and Grading for rules on discussions.
Assigned reading materials:
- CMS (2019) Medicare Fraud and Abuse: Prevention, Detention and Reporting https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
- Mattie, A., & Ben-Chitrit, R. (2009). THE FEDERAL FALSE CLAIMS ACT AND QUI TAM ACTIONS: WHAT EVERY HEALTHCARE MANAGER SHOULD KNOW. Journal of Legal, Ethical and Regulatory Issues, 12(2), 49-68. Retrieved from http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsgbe&AN=edsgcl.209407528&site=eds-live&scope=site
- Frederiksen, M., & Weaver, E. E. (2015). Understanding the federal physician self-referral statute: “stark law”. Journal of Health Care Compliance, 17(2), 47-50,65. Retrieved from Retrieved from http://ezproxy.umgc.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=101416131&site=eds-live&scope=site
- Office of Inspector General, HEAT Provider Compliance Training (n.d.). Comparison of the anti-kickback statute and the stark law. Retrieved from https://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf