decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Physician Practice Model Compliance Plan / Criminal Enforcement Actions Against Physicians
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Article Overview
This premium article surveys criminal enforcement activity involving physicians and related practitioners, with examples drawn from multiple states and federal health care fraud matters. It is aimed at compliance professionals, coders, auditors, and practice managers who need to understand the kinds of misconduct that can trigger criminal cases and the general compliance issues highlighted by those actions. The article covers broad enforcement themes, the agencies involved, and the types of conduct that led to prosecution, sentencing, restitution, and professional sanctions.
Why This Topic Matters
It helps readers understand how fraudulent billing, improper referrals, controlled substances issues, and documentation or licensing problems can lead to criminal exposure beyond ordinary administrative or civil penalties.
What You Will Learn
- How criminal enforcement actions against physicians are described in a compliance context.
- What broad categories of conduct have led to health care fraud cases and related sanctions.
- How federal and state enforcement agencies may be involved in physician-related fraud investigations.
- Why physician practice compliance programs need to account for billing, referral, and controlled-substance risks.
Who Should Read This
- Physicians
- Practice managers
- Medical coders
- Compliance officers
- Auditors
- Billing staff
- Health care attorneys
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