Federal Anti-Fraud Guidelines: A Primer

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DME providers operate in a highly regulated environment. Suppliers must comply with federal anti-fraud laws, state anti-fraud laws, supplier standards, accreditation requirements, and guidance from Medicare, Medicaid and commercial insurers. If a supplier is doing something it should not be doing, then “someone knows about it.” That “someone” can be an employee, a competitor, a referral source, or a government program/contractor.

If a provider violates one or more of the federal anti-fraud laws, then it can have potential criminal liability, potential civil liability, and be subject to payment suspension and PTAN revocation. The risks are too high for the provider to be cavalier regarding compliance with anti-fraud laws. It is important that on a day-to-day basis, the supplier be aware of the applicable federal and state anti-fraud laws and be aware of whether it is in compliance with the laws. Jeff Baird, JD provides the "cliff notes" version of the federal anti-fraud guidance.

Read Jeff Baird's full article from Medtrade.

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