Get to Know the Five Most Important Federal Fraud and Abuse Laws Applying to Physicians...the Impact is Strong!  

Category: Practice Management

By: Julie Sheppard, BSN, JD, CHC

While most medical professionals deserve the trust and respect from the public, there are still cases where fraud and abuse occur within the healthcare system. The laws that combat fraud and abuse are complex, and it is important for physicians and their office managers to understand these laws. Potential violations have strong impact and could result in criminal penalties, civil fines, exclusion from the Federal health care programs, or loss of a medical license from the State medical board.

According to the Office of the Inspector General, the five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark Law), the Exclusion Statute, and the Civil Monetary Penalties Law (CMPL).

These laws are enfo...