The rules of fraud and abuse

Fraud and abuse has become a significant concern to government regulators as the costs of health care continue to rise. Federal regulators along with federal law enforcement agencies have attributed billions of dollars in federal health care program losses to fraud. As a result, federal statutes have been broadened and enforcement resources have been strengthened to combat suspected fraud. Thus, it is imperative that providers have a basic knowledge of the legal rules associated with fraud and abuse. This article seeks to inform health care professionals of the major fraud and abuse statutes that subject them to potential liability, the extent of that liability, and the means by which inadvertent violations can be avoided.