What laws govern CMS fraud, waste, and abuse?

Federal laws meant to combat Medicare fraud, waste, and abuse are given as follows:

False Claims Act (FCA):

• Originating from the Civil War era, it protects the federal government, including Medicare, from fraudulent claims.

• Aims to prevent overcharging and the sale of goods or services below the claimed value.

Anti-Kickback Statute:

• Prohibits healthcare workers from receiving incentives such as money or goods in exchange for patient referrals or generating business.

Physician Self-Referral Law (Stark Law):

• Named after Congressman Pete Stark, it prevents physicians from referring patients to healthcare entities in which they or their family members have a financial interest.

Criminal Health Care Fraud Statute:

• Explicitly prohibits attempts to defraud health benefit programs and obtain money through fraudulent means.

Exclusion Statute:

• Prevents individuals or entities convicted of health care fraud from participating in federal government-sponsored health care programs.

Civil Monetary Penalties Law:

• Empowers the federal government to impose monetary penalties on individuals or entities convicted of health care fraud.

These laws collectively form a robust framework aimed at ensuring the integrity of Medicare programs and deterring fraudulent activities within the healthcare system. They play a crucial role in protecting government resources and maintaining the trust and effectiveness of healthcare programs.