Medicare Fraud Research Paper

Decent Essays
Medicare Fraud Federal directives which oversee Medicare fraud and abuse incorporate all the following: 1) False Claims Act (FCA) 2) Anti-Kickback Statute (AKS) 3) Physician Self-Referral Law (Stark Law) 4) Social Security Act 5) United States Criminal Code. According to the Department of Health and Human Services Centers for Medicare & Medicaid Services, these regulations stipulate the criminal, civil, and administrative alleviates the administration may enforce on persons or entities who perpetrate fraud and abuse in the Medicare Program, including Medicare Parts C & D and the Medicaid Program. Disregarding these regulations may stem in defaulting of claims, Civil Monetary Penalties (CMPs), sanction from all Federal healthcare curriculums,…show more content…
Whereas, “knowing” and “knowingly” mean an individual has authentic understanding of the information or undertaking in premeditated ignorance or irresponsible disrespect of the legitimacy or fallaciousness of the information regarding to the claim. No evidence of definite resolved to deceive is compulsory to infringe the civil FCA; For instance; say a medical doctor deliberately presents claims to Medicare for a greater level of medicinal services than essentially delivered or beyond the medicinal record authenticates. However, civil punishments for infringing the FCA may possibly incorporate fines of equal to three times the total of damages undergone by the administration because of the counterfeit claims in addition to up to $21,563 (as of 2016) per fictitious claim filed. Furthermore, there is a criminal FCA law by which persons or entities who submit bogus claims may face penalties, confinement, or
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