Laws Targeting Physician Behavior

Indeed there are many federal and state laws on the books that target physician behavior. Examples of some key federal laws include Stark, Anti-Kickback, and False Claims. In Florida, there are several additional regulations such as the Patient Self Referral Act and the Patient Brokering Statute. With all the changes going on within the U.S. healthcare industry, I thought I would provide a quick snapshot of healthcare fraud and abuse over the past 4 years.

Obamacare Initiative
Healthcare fraud and abuse is a big undertaking for the U.S. government, but governmental agencies have received help recently. In 2010, Obamacare gave CMS (Centers for Medicare and Medicaid Services) greater authority to battle fraud and abuse and the war has had substantial achievements. From 2010 to 2013, $19.2 billion was collected under the Health Care Fraud and Abuse Control Program.

In 2011, fraud charges were filed against some 1,430 defendants. That same year also saw 743 criminal convictions, 977 new investigations of civil health care fraud and the recovery of $4.1 billion.

Some of the actions have been quite newsworthy. For example, you may recall the raids in May 2012 of 7 U.S. cities which resulted in the arrests of 107 physicians and nurses.

And the Beat Goes On
Approximately 70% of recovery in 2013 from civil fraud, arose from matters involving healthcare fraud. In the first half of 2013, 1,500 individuals were excluded from participation in federal health care programs and 240 civil actions were undertaken by the OIG (Office of Inspector General). Last year saw 638 new prosecutions and the OIG recovered $4.3 billion.

By the end of 2013, new investigations opened involving 1,910 individuals and some 3,500 people were listed in pending investigations. The average prison term for individuals convicted in 2013 of Medicare fraud . . . 52 months!

Local Education

Some groups are taking a proactive stance to educate healthcare providers and managers. The Tampa chapter of PAHCOM (Professional Association of Health Care Office Management) is up and running and helping its members tremendously with a wealth of education from informative speakers. Recently, they received a presentation by Rachel Goodman, a healthcare attorney with Shumaker, Loop & Kendrick. The topic was Health Law 101 and she covered the basics that office managers need to know in order to help protect their physicians’ licenses and the practice as a whole.

Ignorance of the law is no excuse and you should call your attorney with any questions before the OIG comes knocking at your door. If you need help for your medical or dental practice, seek out a consultant experienced with practice operations.


Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at

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