& 3 1. Civil False Claims Act Any person who knowingly presents a claim, record, or statement, or conspires to (same) is liable for $5,000 - $10,000 each claim + 3x the amount of DAS sustained by the gov’t + exclusion from Medicare/Medicaid *knowingly, the scienter: actual knowledge, reckless disregard, deliberate ignorance Qui Tam Actions 2. Illegal Renumeration Act (Anti-kickback statute) 3. Law Does the transaction involve… A physician Making a referral of a m/m patient For a designated health service (DHS) Parenteral (intravenous feeding) and enteral Critical laboratory services nutrients(feeding) Physical therapy services Prosthetics Occupational therapy services Home health services Radiology Outpatient services Radiation therapy services & supplies Prescription Durable Medical Equipment and Supplies To an entity w/ which the physician has a financial relationship Compensation Ownership Investment
& 3 1. Civil False Claims Act Any person who knowingly presents a claim, record, or statement, or conspires to (same) is liable for $5,000 - $10,000 each claim + 3x the amount of DAS sustained by the gov’t + exclusion from Medicare/Medicaid *knowingly, the scienter: actual knowledge, reckless disregard, deliberate ignorance Qui Tam Actions 2. Illegal Renumeration Act (Anti-kickback statute) 3. Law Does the transaction involve… A physician Making a referral of a m/m patient For a designated health service (DHS) Critical laboratory services Physical therapy services Occupational therapy services Radiology Radiation therapy services & supplies Durable Medical Equipment and Supplies Parenteral (intravenous feeding) and enteral nutrients(feeding) Prosthetics Home health services Outpatient services Prescription To an entity w/ which the physician has a financial relationship Compensation Ownership Investment
dodge-health-law-sandra-carnehan-2014.docx