ED Coding & Reimbursement Alert - 2018 Issue 11
Enforcement: Master the Big 3 to Sidestep Medicare Fraud Violations
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Article Overview
This article is a high-level overview of major federal healthcare fraud and abuse laws that affect providers, laboratories, and referral relationships. It discusses how the Anti-Kickback Statute, the False Claims Act, and the Stark Law are framed in enforcement and compliance contexts, along with the kinds of billing and referral concerns that can create risk. The piece is useful for physicians, billing professionals, compliance staff, and laboratory administrators who want to understand the general boundaries of these laws and why they matter to Medicare-related operations.
Why This Topic Matters
These laws shape how referrals, billing, and financial relationships are handled in federally funded healthcare programs. Understanding their scope helps practices reduce compliance exposure and identify situations that may warrant closer legal or compliance review.
Article Sections
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AKS: Steer Clear of Rewards for Referrals
Introduces the Anti-Kickback Statute and discusses its focus on referral-related financial relationships in federal healthcare programs. The section provides general compliance context for provider and laboratory interactions.
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FCA: Avoid the Sting of a Violation
Summarizes the False Claims Act and the kinds of billing and documentation issues that can create exposure under fraud enforcement. It also covers the article’s general discussion of intent, oversight, and claim accuracy.
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Stark: Know These Things the Law Forbids
Explains the Stark Law at a broad level, including its role in physician self-referral and financial relationships tied to designated health services. The section also notes the law’s relationship to exceptions and compliance risk.
What You Will Learn
- How the article frames the three major federal healthcare fraud and abuse laws
- What kinds of provider and laboratory relationships are discussed as compliance concerns
- How billing, referral, and documentation issues are presented in a general fraud-and-abuse context
- Why the Stark Law is treated differently from intent-based enforcement concepts
- What broad categories of risk are associated with Medicare-related fraud violations
Who Should Read This
- Physicians
- Laboratory administrators
- Medical practice managers
- Billing and coding professionals
- Compliance staff
- Healthcare attorneys
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