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Health care fraud is punishable with a fine commensurate with the value of the amount of fraudulently received (or claimed) services and a prison term from a few years’ incarceration to life in prison.
18 U.S. Code § 670
Theft of medical products
18 U.S. Code § 669
Theft or embezzlement in connection with health care.
31 US Code 3729
The Civil False Claims Act protects the Government from being overcharged or sold shoddy goods or services. It is illegal to submit claims for payment to Medicare or Medicaid that a provider knows or should know are false or fraudulent.
42 U.S. Code 1320a–7
OIG is legally required to exclude from participation in all Federal health care programs doctors and entities convicted of the following types of criminal offenses: (1) Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare or Medicaid; (2) patient abuse or neglect; (3) felony convictions for other health-care-related fraud, theft, or other financial misconduct; and (4) felony convictions for unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
42 US Code 1320a-7b(b)
The Anti-kickback statute s a criminal law that prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients).
42 US Code 1320a-7c
The Health Care Fraud and Abuse Control Program is under the joint control of the Attorney General and the Office of Inspector General of Health and Human Services Department.
42 US Code 1395aa
HHS secretary enters into agreements with state agencies to conduct investigations, called surveys, and to certify to the secretary that a provider meets the conditions of participation in federal health insurance program.
42 US Code 1395ddd
Recovery Audit Contractors review and correct improper payments in the Medicare Part A-D and in the Medicare-Medicaid Data Match Program.
42 US Code 1395nn
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
42 US Code 1395w-114
Premium and cost-sharing subsidies for low-income individuals. State Medicaid agencies determine eligibility of Medicare beneficiaries for the low-income subsidy.
Rated mostly true by Politifact in 2014.
Medicare and Medicaid Fraud and Abuse by
Call Number: KF 3608 .A4 M44
Publication Date: 2011
Current version available on the Franklin County Law Library public computers from Westlaw.
Medical Law by
Call Number: KF 3821 .M43
Publication Date: 2015
Medical Plans : COBRA, HIPAA, HRAs and disability by
Call Number: KF 6289 .A1 T35 no.389-5th
Medical Records Privacy under HIPAA by
Call Number: KF 3827 .R4 M34