Medical funding8criminal statutes False Claims Act, 18 U.S.C.§ 287 Holds liable providers who offer false claims and demands to the government for compensation of goods and services.16False Statements Act, 18 U.S.C. §1001 Liability forpresenting fraudulent or false statements or documents in communications.Medical funding criminal statutes cont’6Anti-Kickback Statute (42 U.S.C. Section 132a- 7b (b))Liability for soliciting, paying, offering, or receiving any compensation.15Federal Mail and Wire Fraud: 18 U.S.C. §§1341, 1343 Liability forusing communications forms in fraudulent activities. Physician self-referral law (stark law II) Making referrals with compensation agreements.12Sherman Act, the Clayton Act, and the Federal Trade Commission Act Three cardinal federal antitrust lawsSherman Act ?Outlaws conspiracy, combination, or contract in trade restraint (California Healthcare Foundation, 2002). ?Outlaws combination or conspiracy to monopolize, attempted monopolization, or monopolization. ?Promotes healthy competition.?Prevents plans to divide markets, fix prices, or rig bids. ?Fines and imprisonment to providers. The Clayton Act •Addresses practices not vividly hindered under Sherman Act. •Interlocking directorates and mergers. •Promotes healthy competition (World Health Organization, 2006). •Hinders creation of monopoly. •Bans merchants’ discriminatory allowances, services, and prices. •Private companies sue triple damages.14The Federal Trade Commission Act (FTC) •Bans unfair competitionmethods.•Prevents deceptive or unfair practices or acts•Similar violations as Sherman Act. •Activities punishable in Sherman Act are also punishable in FTC. Stark II statute8of the Medicare and Medicaid Protection Act of 1987?Hinders physicians from making referrals to entities where providers have investment interest of ownership (Rubin, Pronovost&Diette, 2012). ?Entities with compensation agreements.10Anti-Kickback statute of the Medicare and Medicaid Protection Act of 1987•Makes it a criminal misdemeanor to willfully or knowinglysolicit, pay, offer,6or receive any compensation to reward or induce referral of services or itemsreimbursable by a federal program(Bennett, 2012). •The two statutes ensure providers have no financial links
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