Question 1

What federal law prohibits physicians from referring Medicare or Medicaid patients to entities with which they have a financial relationship?

Accepted Answer

The Stark Law (Physician Self-Referral Law). It is a strict liability statute, meaning intent does not need to be proven to establish a violation.

Question 2

Under the False Claims Act, what is the term for a private individual who files a lawsuit on behalf of the government against a fraudulent party?

Accepted Answer

A relator. This type of lawsuit is called a qui tam action, and the relator may receive a portion of any recovered funds.

Question 3

What is the key distinction between healthcare fraud and healthcare abuse?

Accepted Answer

Fraud involves intentional deception or misrepresentation to obtain an unauthorized benefit. Abuse involves practices inconsistent with sound fiscal, business, or medical practices but without proven fraudulent intent.

Question 4

What federal law makes it illegal to offer, pay, solicit, or receive anything of value to induce or reward referrals of federal healthcare program business?

Accepted Answer

The Anti-Kickback Statute (AKS). Violations are considered criminal offenses and can result in exclusion from federal healthcare programs.

Question 5

Which law allows the government to impose civil monetary penalties on individuals or entities that submit false claims to federal healthcare programs, even without criminal prosecution?

Accepted Answer

The Civil Monetary Penalties Law (CMPL). Penalties can include fines per false claim and exclusion from federal healthcare programs.

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