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Posts Tagged ‘Overview’

Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview

A number of federal statutes aim to combat fraud and abuse in federally funded health care programs such as Medicare and Medicaid. Using these statutes, the federal government has been able to recover billions of dollars lost due to fraudulent activities. In March 2010, Congress enacted comprehensive health care reform legislation. One focus of this legislation, the Patient Protection and Affordable Care Act (PPACA) as amended, is improved health care fraud and abuse enforcement. PPACA, among other things, creates new health care fraud enforcement tools and expands upon the types of prohibited conduct. This report provides an overview of some of the more commonly used statutes used to fight health care fraud and abuse and discusses some of the changes made to these statutes by PPACA.

Title XI of the Social Security Act contains Medicare and Medicaid program-related anti-fraud provisions, which impose civil penalties, criminal penalties, as well as exclusions from federal health care programs on persons who engage in certain types of misconduct. PPACA amends these administrative sanctions and authorizes the imposition of several new civil monetary penalties and exclusions.

Under the federal anti-kickback statute, it is a felony for a person to knowingly and willfully offer, pay, solicit, or receive anything of value (i.e., “remuneration”) in return for a referral or to induce generation of business reimbursable under a federal health care program.The statute prohibits both the offer or payment of remuneration for patient referrals, as well as the offer or payment of anything of value in return for purchasing, leasing, ordering, or arranging for, or recommending the purchase, lease, or ordering of any item or service that is reimbursable by a federal health care program. PPACA revises the evidentiary standard under the anti-kickback statute and eliminates the requirement of actual knowledge of, or specific intent to commit a violation of the statute. This amendment may make it easier for the government to prove its case.

The Stark law and its implementing regulations prohibit physician self-referrals for certain health services that may be paid for by Medicare or Medicaid. Under the Stark law, if (1) a physician (or an immediate family member of a physician) has a “financial relationship” with an entity, the physician may not make a referral to the entity for the furnishing of these health services for which payment may be made under Medicare or Medicaid, and (2) the entity may not bill the federal health care program or any individual or entity for services furnished pursuant to a prohibited referral. PPACA limits certain exceptions to the Stark law.

The federal False Claims Act (FCA) imposes civil liability on persons who knowingly submit a false or fraudulent claim or engage in various types of misconduct involving federal government money or property. Health care program false claims often arise in billing, including billing for services not rendered, billing for unnecessary medical services, double billing for the same service or equipment, or billing for services at a higher rate than provided (“upcoding”). Civil actions may be brought in federal district court under the FCA by the Attorney General or by a person known as a relator (i.e., a “whistleblower”), for the person and for the U.S. Government, in what is termed a qui tam action. PPACA appears to make it easier for certain relators to bring qui tam actions, thus potentially allowing some FCA actions to proceed that would have been dismissed under prior law.

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PPACA: A Brief Overview of the Law, Implementation, and Legal Challenges

PPACA: A Brief Overview of the Law, Implementation, and Legal Challenges

In March 2010, the 111th Congress passed health reform legislation, the Patient Protection and Affordable Care Act (P.L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). Jointly referred to as PPACA, the law increases access to health insurance coverage, expands federal private health insurance market requirements, and requires the creation of health insurance exchanges to provide individuals and small employers with access to insurance. The costs for expanding access to health insurance and other provisions are projected to be offset by increased taxes and revenues and reduced Medicare and Medicaid spending. Implementation of PPACA, which is scheduled to unfold over the next few years, involves all the major health care stakeholders, including the federal and state governments, as well as employers, insurers, and health care providers. Following the enactment of PPACA, state attorneys general and others have brought a number of lawsuits challenging provisions of PPACA, including the individual mandate, on constitutional grounds.

This report provides a brief summary of major PPACA provisions, implementation and oversight activities, and current legal challenges. For more detailed information on the topics included in this report, and other information about PPACA, CRS has produced a series of comprehensive reports. The information provided in these reports ranges from broad overviews of PPACA provisions, such as Medicare provisions, to more narrowly focused topics, such as grandfathered health plans.

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Image : http://www.flickr.com Nursing and Home Health Care Overview Home Health Care allows patients and their families to maintain independence and dignity.

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Becoming a Home Health Care Nurse | National Health Care

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Analyst Research on Arena Pharmaceuticals (NASDAQ: ARNA) and Vivus (NASDAQ: VVUS) — Biotech Overview
TORONTO–(Marketwire – 09/09/10) – www.BedfordReport.com has released its latest newsletter providing in-depth analyst research on some of the hottest names in the Biotech industry including Arena Pharmaceuticals, Inc. (NASDAQ: ARNA – News ) and Vivus, Inc. (NASDAQ: VVUS – News ). Register for a free membership today at www.bedfordreport.com[[[SHIFTIN …

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Nashville Public TV’s first documentary in the NPT Reports series serves as an overview of the state of Tennessee’s childrens health. This documentary looks at Tennessee’s high infant mortality and childhood obesity rates, as well as the barriers teens face receiving care for emerging mental health problems. The documentary concludes with a profile of one Nashville HS principal that is combatting poor attendance rates by opening a health care clinic for the community in his school. The documentary is hosted by Kimberly Williams Paisley.

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Cornell University Law School Professor William Jacobsen brave launched today his week long "dart board" analysis of HR 3200, the ObamaCare bill on the House. Selecting random sections of the law to analyze each day this week on his …

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View full post on Open Congress : Blog Articles for H.R.3200 America’s Affordable Health Choices Act of 2009

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Reportlinker Adds Human Embryonic Stem Cells (hESC) – A Global Market Overview
Reportlinker.com announces that a new market research report is available in its catalogue:

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Congressman Dennis Kucinich speaks about health care bill. Video provided by Chad Ely. Come and visit kucinich.us

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