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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