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Phantom Billing, Fake Prescriptions, and the High Cost of MedicineHealth Care Fraud and What to Do about It$
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Terry L. Leap

Print publication date: 2011

Print ISBN-13: 9780801449796

Published to Cornell Scholarship Online: August 2016

DOI: 10.7591/cornell/9780801449796.001.0001

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The Major Health Care Fraud Laws

The Major Health Care Fraud Laws

(p.41) 2 The Major Health Care Fraud Laws
Phantom Billing, Fake Prescriptions, and the High Cost of Medicine

Terry L. Leap

Cornell University Press

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.

Keywords:   health care fraud, anti-kickback statute, Stark Law, self-referrals, false claims statutes, Health Insurance Portability and Accounting Act 1996, Federal Food, Drug and Cosmetic Act, kickbacks, False Claims Act

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