Fraud and abuse provisions in the Health Insurance Portability and Accountability Act: a guide to the new act for...

The Health Insurance Portability and Accountability Act, many provisions of which became effective on January 1, 1997, will have a significant impact in the area of health care fraud and abuse. This article examines the fraud and abuse provisions of the new act from the point of view of the practicing physician. The greatest impact on the health care provider will come from the increased enforcement resources which will be available as a result of the act. The act also contains some particular substantive additions to health care fraud and abuse law which will be applicable to physicians, including provisions penalizing health care fraud, wrongful disclosure of individually identifiable health information, false certification for home care, and false statement to a health benefit program.