PDF Archive

Easily share your PDF documents with your contacts, on the Web and Social Networks.

Send a file File manager PDF Toolbox Search Help Contact



Are you aware of Medicare Fraud and Abuse .pdf



Original filename: Are you aware of Medicare Fraud and Abuse.pdf
Author: Jessica Parker

This PDF 1.5 document has been generated by Microsoft® Word 2010 Trial, and has been sent on pdf-archive.com on 09/11/2018 at 13:59, from IP address 103.68.x.x. The current document download page has been viewed 24 times.
File size: 308 KB (3 pages).
Privacy: public file




Download original PDF file









Document preview


Are you aware of Medicare Fraud and Abuse?

Most physicians strive to work ethically, provide high-quality medical care to their patients,
and submit proper claims for payment. Trust is at the core of the physician-patient
relationship. The Federal Government also places enormous trust in physicians. Medicare and
other Federal health care programs rely on physicians’ medical judgment to treat patients with
appropriate, medically necessary services.
“Federal health care programs rely on physicians to submit accurate claims when requesting
payment for Medicare-covered health care items and services. The presence of some
dishonest health care professionals who exploit Federal health care programs for illegal
personal gain creates the need for laws that combat fraud and abuse and ensure appropriate
quality medical care”- As mentioned in a document ‘Avoiding Medicare Fraud-Roadmap for
Physicians’ from www.cms.gov
While active Medicare abuse is a massive problem, there are many more times that a practice
simply has sloppy business practices that lead to simple oversights -- such as failing to
understand government reporting regulations or claims that simply don't add up.
Unfortunately, even the most innocent practice provider is still liable if business practice
mismanagement causes unintentional Medicare fraud. Even if you believe that you're doing
Call now 888-357-3226 (Toll Free)
info@medicalbillersandcoders.com

1

www.medicalbillersandcoders.com
Copyright ©-2018 MBC. All Rights Reserved

everything right -- providing legitimate services and billing accordingly -- your practice may still
be charged with health care fraud. Essentially, good intentions will no longer keep you out of
trouble with regulatory agencies.
The Centers for Medicare and Medicaid Services (CMS) recently published a high-level
overview targeted to help physicians stay within the spirit and the letter of the laws around
Medicare and Medicaid billing. The following Federal fraud and abuse laws apply to physicians:
Federal False Claims Act (FCA):
The civil FCA protects the Federal Government from being overcharged or sold substandard
goods or services. The FCA imposes civil liability on any person who knowingly submits, or
causes the submission of, a false or fraudulent claim to the Federal Government. An example
may be a physician who knowingly submits claims to Medicare for medical services not
provided.
Anti-Kickback Statute (AKS):
The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay,
solicit, or receive any remuneration to induce or reward referrals of items or services
reimbursable by a Federal health care program. Where a provider offers, pays, solicits, or
receives unlawful remuneration, the provider violates the Anti-Kickback Statute.
Remuneration includes anything of value such as cash, free rent, expensive hotel stays and
meals, and excessive compensation for medical directorships or consultancies. If an
arrangement, however, satisfies certain regulatory safe harbors, it may not implicate the AntiKickback Statute. Civil penalties for violating the Anti-Kickback Statute may include penalties of
up to $50,000 per kickback plus three times the amount of kickback. Criminal penalties for
violating the Anti-Kickback Statute may include fines, imprisonment, or both.
Physician Self-Referral Law (Stark Law):
The Physician Self-Referral Law often called the Stark Law, prohibits a physician from referring
for certain designated health services payable by Medicare or Medicaid to an entity where the
physician (or an immediate family member) has an ownership/investment interest or a
compensation arrangement unless an exception applies.
Call now 888-357-3226 (Toll Free)
info@medicalbillersandcoders.com

2

www.medicalbillersandcoders.com
Copyright ©-2018 MBC. All Rights Reserved

Criminal Health Care Fraud Statute:
The Criminal Health Care Fraud prohibits knowingly and willfully executing, or attempting to
execute, a scheme or artifice in connection with the delivery of or payment for health care
benefits, items, or services to: Defraud any health care benefit program; or Obtain (by means
of false or fraudulent pretenses, representations, or promises) any of the money or property
owned by, or under the custody or control of, any health care benefit program. Penalties for
violating the Criminal Health Care Fraud Statute may include fines, imprisonment, or both.
Civil Monetary Penalties Law (CMPL):
The Civil Monetary Penalties Law authorizes CMPs for a variety of health care fraud violations.
The CMPL provides for different amounts of penalties and assessments based on the type of
violation. CMPs may assess up to three times the amount claimed for each item or service or
up to three times the amount of remuneration offered, paid, solicited, or received. Violations
supporting CMPL actions include:
 Presenting a claim you know, or should know, is for an item or service not provided as
claimed or is false and fraudulent
 Presenting a claim you know, or should know, is for an item or service for which
Medicare will not pay
 Violating the AKS
To avoid such issues, Medical Biller and Coders (http://www.medicalbillersandcoders.com)
suggest conducting audits on a sampling of charts at least annually to monitor compliance;
Focus, especially on high-risk areas.






Establish documentation standards and procedures
Routinely ensure all contracts remain in compliance and they have not expired
Designate a compliance officer
Train and educate
Communicate and implement disciplinary standards

Call now 888-357-3226 (Toll Free)
info@medicalbillersandcoders.com

3

www.medicalbillersandcoders.com
Copyright ©-2018 MBC. All Rights Reserved


Are you aware of Medicare Fraud and Abuse.pdf - page 1/3
Are you aware of Medicare Fraud and Abuse.pdf - page 2/3
Are you aware of Medicare Fraud and Abuse.pdf - page 3/3

Related documents


PDF Document are you aware of medicare fraud and abuse
PDF Document oigs voluntary compliance to medical billing companies
PDF Document importance of hipaa compliance for your practice
PDF Document untitled pdf document 3
PDF Document criminal law restricted drugs and medications in the uae
PDF Document 6 documentation rules every facility should follow


Related keywords