Health Care Fraud and Abuse

A variety of federal and state laws prescribe requirements for healthcare providers who seek reimbursement under governmentally-funded healthcare programs. Violations of these requirements can give rise to civil and criminal penalties. Penalties may be imposed through administrative proceedings or through law suits brought either by the government or by private parties (“qui tam” actions). This course will examine the major federal legislation—the Medicare and Medicaid Antikickback statute, the False Claims Act, and the Stark I and Stark II legislation and regulations, as well as parallel state enactments.