Implications of fraud and abuse in interventional pain management

The federal government has enacted a comprehensive strategy to fight healthcare waste, fraud and abuse. As a result of the federal government's comprehensive strategy, in 2002, the Office of Inspector General announced that improper Medicare payments to doctors, hospitals and other healthcare providers declined 54% from the fiscal year 1996 to the fiscal year 2001. The Office of Inspector General in its 2002 work plan focuses on procedure coding for outpatient services billed by hospital and doctor, coding for evaluation and management services in physician offices and conditions under which a doctor's bill is "incident to" services or supplies among other things. The distinction between fraud and abuse can be very important in determining the potential fines and penalties that might apply, even though it is not clear. Fraud is much more serious than abuse. The degree of intent by the individual or entity under investigation is often the determining factor. The most commonly used statutes for prosecuting or facilitating such a prosecution of healthcare fraud or abuse include HIPAA of 1996, the False Claims Act, healthcare fraud, theft or embezzlement, obstruction of criminal investigations of healthcare offenders, the False Statement Statute, mail and wire fraud statutes, the Social Security Act Civil Monetary Penalties, criminal penalties, and/or Stark laws. This review focuses on various aspects of implications of fraud and abuse in interventional pain management practices including various activities of potential fraud and abuse.