2023 Board Resources

COMMON FRAUD AND ABUSE AND OTHER LEGAL ISSUES BY: Tony R. Maida, McDermott Will & Emery, LLP September 13, 2019 Edition

TABLE OF CONTENTS

Page

ARTICLE 1

ANTI-KICKBACK STATUTE ....................................................................... 1

1.1 Description of Statute and Penalties ...................................................................... 1 1.2 Statutory Exceptions .............................................................................................. 1 1.3 Safe Harbors........................................................................................................... 2 1.4 Advisory Opinion Process ..................................................................................... 3 1.5 OIG Bulletins, Fraud Alerts, Compliance Program Guidance, and Other Guidance ................................................................................................................ 3 ARTICLE 2 THE STARK LAW.......................................................................................... 4 2.1 Description of Statute ............................................................................................ 4 2.2 Penalties ................................................................................................................. 6 2.3 Statutory and Regulatory Exceptions..................................................................... 7 ARTICLE 3 FALSE CLAIMS ACT .................................................................................... 8 3.2 Theories of Liability; Falsity ................................................................................. 9 3.3 Penalties ................................................................................................................. 9 3.4 Qui Tam Actions.................................................................................................... 9 ARTICLE 4 CIVIL MONETARY PENALTIES ............................................................... 10 4.1 Description of Statute .......................................................................................... 10 4.2 Penalties ............................................................................................................... 11 4.3 Self-Disclosure Protocol ...................................................................................... 11 ARTICLE 5 EXCLUSION................................................................................................. 13 5.1 Description of Statute .......................................................................................... 13 5.2 Mandatory Exclusions ......................................................................................... 13 5.3 Permissive Exclusions ......................................................................................... 14 ARTICLE 6 60-DAY OVERPAYMENT RULE ............................................................... 15 6.1 Description of Statute .......................................................................................... 15 6.2 Penalties ............................................................................................................... 16 ARTICLE 7 SUSPENSION AND REVOCATION........................................................... 16 7.1 Suspension ........................................................................................................... 16 7.2 Revocation ........................................................................................................... 17