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Medicare fraud and abuse: implications for physicians.
The Journal of Medical Practice Management : MPM
|January 4, 1989
Summary
Physicians face income opportunities with potential fraud and abuse liability under Medicare. New laws update anti-fraud provisions, impacting practice arrangements and physician sanctions.
Area of Science:
- Healthcare Law
- Medical Practice Management
- Federal Regulations
Background:
- Physicians face increasing financial pressures due to cost-cutting measures like the Prospective Payment System and physician fee freezes.
- New income-generating opportunities for medical practices often carry risks of civil and criminal liability under federal anti-fraud laws.
Purpose of the Study:
- To inform physicians about potential liabilities associated with practice-related financial opportunities.
- To explain the implications of updated federal anti-fraud and abuse laws on medical practices.
Main Methods:
- Review of federal Medicare anti-fraud and abuse provisions.
- Analysis of the Medicare and Medicaid Program Patient Protection Act of 1987.
- Discussion of common joint venture, incentive, and contract arrangements in medical practice.
Main Results:
- Federal laws prohibit specific activities that could lead to criminal and civil liability for physicians.
- The Medicare and Medicaid Program Patient Protection Act of 1987 expanded sanctions for violations.
- Common practice arrangements may fall under scrutiny of anti-fraud and abuse laws.
Conclusions:
- Physicians must be aware of federal anti-fraud and abuse laws when considering new practice opportunities.
- Understanding these laws is crucial for avoiding legal repercussions and sanctions.
- Compliance with updated regulations is essential for navigating financial arrangements in medical practice.