
Contents
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Kickbacks, Self-Referrals, and False Claims Kickbacks, Self-Referrals, and False Claims
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Federal Fraud Laws and Health Care Federal Fraud Laws and Health Care
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The Antikickback Statute The Antikickback Statute
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The Stark Law The Stark Law
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False Claims Statutes False Claims Statutes
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Health Insurance Portability and Accountability Act of 1996 Health Insurance Portability and Accountability Act of 1996
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The Federal Food, Drug, and Cosmetic Act The Federal Food, Drug, and Cosmetic Act
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2 The Major Health Care Fraud Laws
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Published:March 2011
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Abstract
This chapter discusses the major health care fraud laws in the United States. There are five laws that are specific to health care fraud and abuse: the 1972 anti-kickback statute, the Stark Law prohibiting self-referrals by physicians, the false claims statutes, the Health Insurance Portability and Accounting Act of 1996 (HIPAA), and the Federal Food, Drug and Cosmetic Act. The chapter examines each of these laws, beginning with the 1972 anti-kickback law, which prohibits the solicitation or receipt of payments—that is, kickbacks—in return for referring patients to purchase products or services paid for by Medicare, Medicaid, or other federally funded health care programs. It then considers the Stark Law, the false claims statutes that includes the False Claims Act, and the HIPAA. Finally, it evaluates the Federal Food, Drug, and Cosmetic Act.
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