As a physician, you have an obligation to comply with ethical standards as outlined in the Hippocratic Oath. Part of that ethical compliance involves obeying the law.
There are several federal laws that deal specifically with fraud and abuse in the health care industry that you must be aware of and comply with. Failure to do so could not only endanger your medical license but also incur civil fines and/or criminal penalties. The Exclusion Statute prevents you from participating in federal health care programs (e.g., TRICARE or Medicaid) if you have a history of conviction on certain criminal offenses:
- Unlawful drug manufacture
- Financial misconduct
- Patient abuse
The Exclusion Statute applies to offenses committed in the past. The following statutes detail other fraudulent activities to avoid in the present.
1. Anti-Kickback Statute
Under the Anti-Kickback Statute, it is unlawful to pay or receive remuneration in exchange for patient referrals. “Remuneration” is a broad term that can include not only cash but anything of value, such as free meals or hotel stays. Violation of the Anti-Kickback Statute can incur criminal charges.
2. False Claims Act
The purpose of the False Claims Act is to prevent you from fraudulently overcharging Medicare or Medicaid for goods and services, presumably for the purpose of collecting the surplus. The name “False Claims Act” actually refers to two different laws, one of which imposes criminal penalties and the other civil fines. Violation of either could mean the loss of your license.
3. Physician Self-Referral Law
With a few exceptions this statute, also called the Stark law, prohibits you from referring a patient to an entity with whom you or a member of your immediate family has a financial relationship to receive “designated health services.” Examples of these services include home health, prosthetics, physical therapy and radiology.
