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Medicaid/Medicare fraud and abuse: practical guidelines for physicians
The Medical Staff Counselor
|March 5, 1988
Summary
Physicians face risks with Medicare and Medicaid Fraud and Abuse laws, especially regarding illegal referrals in new business ventures. This guide offers strategies to structure arrangements that comply with regulations and minimize legal exposure.
Area of Science:
- Healthcare Law
- Medical Business Ethics
- Regulatory Compliance
Background:
- Physicians exploring new business arrangements face significant legal scrutiny.
- Interpretations of Medicare and Medicaid Fraud and Abuse laws present a threat to these ventures.
Purpose of the Study:
- To identify business arrangements that are likely to comply with Fraud and Abuse laws.
- To illustrate how modifications to business structures can increase the risk of illegal referral charges.
Main Methods:
- Analysis of administrative and judicial interpretations of Medicare and Medicaid Fraud and Abuse laws.
- Case examples of compliant and high-risk business arrangements.
Main Results:
- Specific examples of business arrangements that mitigate the risk of Fraud and Abuse claims.
- Identification of modifications that elevate the likelihood of government charges for illegal referrals.
Conclusions:
- Understanding legal interpretations is crucial for physicians entering new business arrangements.
- Strategic structuring of healthcare business ventures can prevent allegations of fraud and abuse.