Guide · Healthcare
Health Care Fraud and Abuse: A Comprehensive Guide to the Anti-Kickback Statute, Stark Law, and Overpayments
42 U.S.C. § 1320
- Type
- Guide
- Jurisdiction
- National
- Date
- 2024-10-21
- Topic
- Healthcare
This guide states the law governing health care fraud and abuse. Part 1 covers the Anti-Kickback Statute, its elements, the one-purpose test, its voluntary safe harbors, and the advisory opinion process. Part 2 covers the Stark Law, its strict liability structure, the designated health services it reaches, and the mandatory exceptions that distinguish it from the kickback regime. Parts 3 and 4 cover the False Claims Act — including materiality and scienter after Escobar and SuperValu, the qui tam procedure, and the retaliation provision — together with the sixty-day overpayment rule that converts retained overpayments into false claims. Parts 5 and 6 cover exclusion, civil monetary penalties, and the criminal statutes, including the scienter holding of Ruan. Parts 7 and 8 cover the self-disclosure protocols, corporate integrity agreements, compliance program elements, and investigation response. Later parts address value-based arrangements, the enforcement patterns that recur in each sector, and the state statutes that frequently reach further than federal law.
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