Federal Regulations That Apply to Compliance Programs

Federal Regulations & Statutes

Q: What are some of the federal regulations a practice must follow for compliance?

A: Below are seven statutes that apply to a compliance program:

  • federal anti-kickback statutes, which govern the referral relationship between providers and facilities.
  • the federal Physician Self-Referral Law, often called the Stark Law, which prohibits referrals for certain health services to entities that have a financial investment.
  • the False Claims Act, used to combat fraud and abuse in areas such as Medicare and Medicaid programs.
  • the Civil Penalties Statute, giving the government the power to levy fines for violation of a statute.
  • the exclusionary authority of the Office of Inspector General (OIG), which can be used to exclude an individual or a facility from a federal healthcare program because of previous fraud and abuse violations.
  • the Criminal Health Care Fraud statute, used by the OIG and the Department of Justice in an effort to stop fraud in healthcare programs.
  • HIPAA privacy/security rules.

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The information included here is for informational purposes only, is not exhaustive of all considerations when creating documents, is not intended to be legal advice, and should not be relied upon for that purpose. We strongly recommend you consult with an attorney and do not attempt to create your own documents.