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Fraud and Abuse Laws Thirty (30) states and the District of Columbia have enacted false claims statutes so this week you will examine the federal False Claims Act and its application in the practice and business of healthcare. T

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Fraud and Abuse Laws Thirty (30) states and the District of Columbia have enacted false claims statutes so this week you will examine the federal False Claims Act and its application in the practice and business of healthcare. T Fraud and Abuse Laws Thirty (30) states and the District of Columbia have enacted false claims statutes so this week you will examine the federal False Claims Act and its application in the practice and business of healthcare. The National Health Care Anti-Fraud Association estimates that healthcare fraud costs the United States about $53 billion annually. Some other sources have this amount ranging from $100 to $450 billion. Fraud is a criminal violation and is defined by Title 13 United States Code Section 134?. as ‘knowingly and willfully executing. or attempting to execute. a scheme or artifice to defraud any health care benefit program; or to obtain. by means of false or fraudulent pretenses. representations. or promises. any of the money or property owned by. or under the custody or control of. any health care benefit program.” While important to know. the legal definition of fraud is a mouthful. In plain English, healthcare fraud is an intentional deception or misrepresentation of fact that can result in unauthorized healthcare benefits or payment [someone lies to get money they do not deserve). In contrast to fraud, abuse does not require intent and knowledge of wrongdoing. This being the case: abuse is defined as “healthcare rofessionals’ practices that are inconsistent with sound fiscal: business: or medical practices: and result in an unnecessary cost to the Medicaid program: or in reimbursement for services that are not medically necessary or tflat fail to meet professionally recognized standards for health care.

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