Fraud and Abuse Laws

Federal fraud and abuse laws consist of several statutes aimed at preventing conflicts of interest between a provider’s financial incentives and best patient care practices.

Health care professionals are prohibited from presenting claims for services that the individual knows were not provided to the patient. Individuals and entities are prohibited from knowingly making false statements or representations in applying for benefits or programs under all federal and state health care programs. Physicians and their immediate family who own a clinical services facility are prohibited from making referrals to it.

Violations may result in steep fines or felony conviction, with penalties including imprisonment. These fraud and abuse laws can be implicated in a variety of health care contracts and arrangements such as clinical services agreements, joint venture arrangements, and certain educational grants. Avoid these harsh punishments and contact our office to help you ensure proper compliance to these federal laws.