Enforcement: Master the Big 3 to Sidestep Medicare Fraud Violations

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

1. 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.

2. 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.

3. 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.