Medicare Fraud Laws
Title XI of the Social Security Act includes Medicare and Medicaid program-related anti-fraud laws, which not only punish violators with civil and criminal penalties, but also possible exclusion from federal health care programs. The laws address Medicare fraud, which occurs when providers bill Medicare for services or supplies Medicare patients don’t receive. They also tackle the illegal activities associated with Medicare abuse–when doctors, suppliers and others don’t follow good medical practices, resulting in unnecessary costs to Medicare, improper payments, or services that aren’t medically necessary.
Having Medicare fraud laws in place is especially important given this type of fraud’s financial toll. The Medicare program makes about $500 billion in payments each year. In fiscal year 2010, almost $48 billion (or nearly 10% of the government’s payments) were improper and the result of fraud.
Some of the more commonly used laws, or statutes, to fight heath care fraud and abuse were amended in March 2010, with passage of legislation aimed at improving health care fraud and abuse enforcement, called the Patient Protection and Affordable Care Act (PPACA).
Specific laws
Federal Civil Monetary Penalties (Section 1128A of the Social Security Act/42 USC 1320a-7aa)
“Stark I, II”/Physician Self-Referral Law (Section 1877 of the Social Security Act/42 USC 1395nn)
Federal Civil False Claims Act (31 USC 3829-3733)
Health Care Fraud and Scheme (18 USC 1347)
Theft or Embezzlement in Connection with Health Care Benefit Program (18 USC 669)
Obstruction of Criminal Investigations of Health Care Offenses (18 USC 1518)
False Statements Relating to Health Care Matters (18 USC 1035)