Shared Flashcard Set

Details

PT Ethics - Fraud
N/A
8
Health Care
Graduate
10/04/2011

Additional Health Care Flashcards

 


 

Cards

Term
Fraud
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

Term
Abuse
Definition

inappropriate care that resutls in unnecessary costs for medically unnecessary or inadequate services

- ex: excessive charges, overutilization, billing for medically unnecessary care

Term
False Claims Act
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

Term
False Claims Social Security Act
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
Term
Anti-Kickback Statute
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
Term
Stark Laws
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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