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医疗服务提供者需要了解的《虚假索赔法》相关内容。

What providers need to know bout the False Claims Act.

作者信息

Vogel R L

出版信息

Healthc Financ Manage. 1996 Mar;50(3):50-2, 54.

Abstract

In the 1990s, the Federal government's antifraud efforts increasingly have focused on the healthcare industry, and the False Claims Act, a powerful law designed to curb fraud against the Federal Treasury, has been one of the government's most potent weapons. One reason for the act's potency is its qui tam provision, which encourages whistleblowers to expose fraud in return for a substantial percentage of money the government recovers. The False Claims Act has been used against healthcare providers in the following areas: billing for services or supplies not actually provided, billing for nonreimbursable services, using false diagnoses to justify claims, and cheating in government performance evaluations.

摘要

20世纪90年代,联邦政府打击欺诈的努力越来越多地集中在医疗行业,而《虚假索赔法》作为一项旨在遏制针对联邦财政欺诈行为的有力法律,一直是政府最有力的武器之一。该法案效力强大的一个原因是其qui tam条款,该条款鼓励举报人揭露欺诈行为,以换取政府追回资金的很大一部分。《虚假索赔法》已被用于针对医疗服务提供者的以下领域:为实际未提供的服务或用品计费、为不可报销的服务计费、使用虚假诊断来证明索赔合理以及在政府绩效评估中作弊。

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