NCJ Number
178089
Journal
American Criminal Law Review Volume: 36 Issue: 3 Dated: Summer 1999 Pages: 773-807
Date Published
1999
Length
35 pages
Annotation
The laws covering Federal health care fraud and its enforcement are examined, with emphasis on the general Federal laws used to prosecute health care fraud, the laws specifically enacted to address Medicare and Medicaid fraud, Federal and State enforcement efforts, and recent developments.
Abstract
Federal and State agencies have made the prosecution of health care fraud a primary focus, because health care fraud is costing taxpayers nearly $100 billion per year. The general Federal laws used to prosecute health care fraud include the False Claims, False Statements, and Mail and Wire Fraud Acts. Laws specifically aimed at Medicare and Medicaid fraud provide that any person or legal entity that provides goods or services for health care may be subject to civil or criminal sanctions if delivery or performance of those goods or services involves fraud or abuse. These laws include safe harbor provisions that shield physicians from anti-kickback legislation if the physician complies fully with the provisions. Enforcement of health care fraud violations requires coordination and cooperation among Federal and State government agencies. The three main Federal agencies involved are the Department of Health and Human Services, the Department of Justice, and the Federal Bureau of Investigation. Footnotes