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The Difference Between Fraud and Abuse

Fraud is defined as the purposeful deceit or distortion of the truth that results in the receipt of unfair advantage or payment. Abuse is defined as activities that are inappropriate, unethical, outside of accepted professional responsibility norms, or clinically unwarranted. This work was written to study the laws associated with these concepts and understand why medical workers need to know about these laws.

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The Stark Regulations are a series of federal laws that restrict doctors from recommending Medicare or Medicaid clients to any health facility in which they have a financial stake. Unless an exemption exists, the Stark Law forbids a physician from referring certain defined medical services funded by Medicare to an organization with which they have a financial connection, and the organization obtains the reference from filing claims to Medicare for those suggested treatments.

The Stark Law only applies to federally funded services such as Medicare and Medicaid. This involves a doctor’s capital formation and ties with independent contractors. On-site lab and imaging operations are an exception. In other words, if the physician does an EKG or takes blood in the office, it is not against the law. To summarize, every state is required to observe these national rules. If a doctor violates the law, all money obtained must be returned.

The Emergency Medical Treatment and Labor Act (EMTALA) requires clinicians in hospital emergency rooms to provide a health assessment investigation to anyone who arrives at the emergency room and demands one. It prevents healthcare facilities with hospital emergency rooms from denying to investigate or treat these people with an urgent situation health conditions. Corporate compliance, regardless of sector, should be a vital element of corporate operations.

Corporate compliance infractions can lead to fines, sanctions, litigation, reputational damage, and other consequences (Szalados, 2021). An efficient program enhances communication between management and employees. It should contain a procedure for developing, revising, disseminating, and monitoring guidelines and policies. Summing up, these laws regulate the flow of money in medical institutions, which is normal since high-quality services should be provided throughout the country. Only those institutions that need it should use the state service in the form of Medicare.

Reference

Szalados, J. E. (2021). Regulations and Regulatory Compliance: False Claims Act, Kickback and Stark Laws, and HIPAA. The Medical-Legal Aspects of Acute Care Medicine: A Resource for Clinicians, Administrators, and Risk Managers, 277.

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StudyCorgi. (2023, January 3). The Difference Between Fraud and Abuse. Retrieved from https://studycorgi.com/the-difference-between-fraud-and-abuse/

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StudyCorgi. (2023, January 3). The Difference Between Fraud and Abuse. https://studycorgi.com/the-difference-between-fraud-and-abuse/

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StudyCorgi. "The Difference Between Fraud and Abuse." January 3, 2023. https://studycorgi.com/the-difference-between-fraud-and-abuse/.

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StudyCorgi. 2023. "The Difference Between Fraud and Abuse." January 3, 2023. https://studycorgi.com/the-difference-between-fraud-and-abuse/.

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StudyCorgi. (2023) 'The Difference Between Fraud and Abuse'. 3 January.

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