3 federal fraud and abuse laws explained

May 23, 2017

Blog Post

Health care fraud and abuse issues continue to be an area of focus and enforcement for the government. The legal framework and regulations can be intimidating. The chart below compares the three most common federal health care fraud and abuse laws. It is intended as background and to increase your basic understanding of these laws.

For a review or analysis of relationships or claims, or for more information, please contact the attorneys listed below.

Over the past 24 months, the U.S. Department of Health and Human Services Office for Civil Rights has brought notable enforcement efforts against several non-profit covered entities and business associates, resulting in instances of six and seven-figure penalties against providers across the county for incidents involving breaches of protected health information.

A new amendment to New York state law, which would have required all healthcare providers to obtain separate consents from patients for treatment and payment is on hold until further guidance is released, according to the New York Department of Health.

On November 1, 2024, the Centers for Medicare & Medicaid Services issued the Medicare Physician Fee Schedule 2025 final rule, which establishes new advanced primary care management billing codes that will expand opportunities for physician practices, federally qualified health centers, rural health clinics and other health care providers to get paid for services provided by clinical staff under the direction of a physician, nurse practitioner or physician assistant beginning January 1, 2025.

3 federal fraud and abuse laws explained

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