Term
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Definition
intentional deception or misrepresentation of facts with intent to gain unauthorized benefit
- ex: billing for services not rendered, alterning cliam forms for higher amount |
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Term
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Definition
inappropriate care that resutls in unnecessary costs for medically unnecessary or inadequate services
- ex: excessive charges, overutilization, billing for medically unnecessary care |
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Term
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Definition
- prohibits falsifying claims to government
- penalties include: triple damages, plus mandatory minimum payment of 5500-11000 per false claim, criminal penalties
- Ex: unbundling, upcoding, flasifying medical record |
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Term
| False Claims Social Security Act |
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Definition
| = felony to knowingly and willfully make or cause to be made false statements of a meterial fact in any application for payment or for use in determining rights to such payment under Medicare or Medicaid |
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Term
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Definition
| whoever knowingly solicits or receives aany renumeration directly or indirectly in case or in kind for: reffering an individual, purchains, leasing or arranging for or recommending purchase of goods or services |
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Term
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Definition
| prohibits physician from referring Medicare or Medicaid patients to certian entities in which the physician or an immediate family member has an invesment interest or compensation agreement |
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