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Medical Ethics |

Kickbacks, Self-Referrals, and False ClaimsKickbacks, Self-Referrals, and False Claims: The Hazy Boundaries of Health-care Fraud

Joan H. Krause, JD
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From the UNC School of Law, Chapel Hill, NC.

Correspondence to: Joan H. Krause, JD, UNC School of Law, Van Hecke-Wettach Hall, CB #3380, Chapel Hill, NC 27599-3380; e-mail: jhkrause@email.unc.edu


Editor’s note: This essay is the eighth article in the Law and Medicine curriculum of the ongoing “Medical Ethics” series. To view all articles from the core curriculum, visit http://journal.publications.chestnet.org/collection.aspx?categoryid=9186.—Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):1045-1050. doi:10.1378/chest.12-2889
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The fraud and abuse laws that govern conduct related to the federal health-care programs, such as Medicare and Medicaid, impose broad and complex limitations on billing practices and financial relationships among providers. Given the potential consequences of engaging in fraudulent behavior, it is crucial that physicians appreciate the types of activities that may run afoul of these laws. This article summarizes the major aspects of the fraud laws that are most likely to have a daily impact on physician practice: the Civil False Claims Act, the Medicare and Medicaid Anti-Kickback Statute, and the so-called Stark Law prohibition on physician self-referrals.


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