Medicare/Medicaid Fraud & Abuse

Overview

The Physician Self-Referral (Stark) Law and Anti-Kickback Statute (often referred to collectively as the fraud and abuse laws) are federal laws that apply to financial relationships that health care providers have with physicians and other referral sources. These laws are intended to protect the fiscal soundness of programs such as Medicare and Medicaid as well as patients covered by those programs from biased medical decision-making and increased costs. From sole practitioners to large health systems, all providers need an understanding of how to comply with the fraud and abuse laws and avoid violations. The financial penalties under these laws are draconian often resulting in eight- and nine-figure settlements. In addition, health care providers violating the Anti-Kickback Statute face the possibility of imprisonment.

Several attorneys in Bricker’s health care practice focus specifically on fraud and abuse laws. Our team helps providers identify potential problem areas and proactively find solutions that reduce risk. When necessary, we help our clients resolve compliance issues by investigating potential violations, developing corrective action/remediation plans, and addressing problems effectively. We also help our clients defend qui tam (whistleblower) lawsuits and government investigations that pertain to fraud and abuse laws.

This resource center outlines the statutes, regulations, and other documentation regarding Medicare and Medicaid fraud and abuse and provides a consolidated guide to regulation updates.