Play video

Enforcement Mechanisms

Learn about the interrelationship between the three main fraud-and-abuse laws, public enforcement, private enforcement generally, and self-reporting programs.

Transcript

Three primary federal laws used to combat healthcare fraud and abuse are the False Claims Act, the Anti-Kickback Statute, and the Stark Law. The False Claims Act prohibits false claims to the government for money, such as false claims for Medicare reimbursement. The Anti-Kickback Statute and the Stark Law both prohibit kickbacks for referring Medicare patients for treatment. However, the Anti-Kickback Statute is criminal and has a broader reach, and the Stark Law is civil and has a narrower...

Lessons

1. Welcome
  • Welcome to Healthcare Law
2. Health Insurance
3. The Structure of Healthcare Entities
  • The Professional Workforce
  • Forming a Healthcare Entity
  • Fiduciary Duties at Healthcare Entities
  • Tax-Exempt Status
  • Joint Ventures and Tax-Exempt Status
4. Fraud and Abuse in Healthcare
5. Antitrust Issues in Healthcare
  • Overview of Antitrust Laws in Healthcare
  • Mergers and Acquisitions in Healthcare
  • Working with Competitors
  • Payers with Market Power
6. Tort Liability of Healthcare Entities
  • The Physician-Patient Relationship
  • Physician Duties Regarding Information
  • Physician Duties Regarding Clinical Care
  • Hospital and Health Plan Liability
7. Recurring Legal Issues in Patient Care
8. Public Health Law