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Fraud, Waste and Abuse (FWA)

 Most doctors work ethically, providing high-quality medical care, and ensuring the submittal of proper claims for payment.

Federal and state governments place a great amount of trust in physicians. Medicare, Medicaid and other government health care programs rely on physicians’ medical judgment to treat patients with appropriate services. When reimbursing physicians, hospitals, labs, and durable medical equipment suppliers for services provided to program patients, the federal government relies on physicians to submit accurate and truthful information.

Unfortunately, dishonest providers who exploit the health care system for illegal personal gain have created the need for laws that combat fraud and abuse and that ensure appropriate quality medical care. Some of those laws are listed below:

  • Anti-Kickback Statute (42 USC § 1320a-7b(b))
  • Stark Law (42 USC § 1395nn)
  • Federal False Claims Act 31 (U.S.C. §§ 3729 – 3733)

The Centers for Medicare and Medicaid Services (CMS) helps physicians understand how to comply with federal laws by identifying "red flags" that could lead to potential liability in law enforcement and administrative actions. For more information, read Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians.

Protecting your medical practice against health care fraud is important too. CMS provides training on safeguarding your medical identity.