Major Laws Related to

Healthcare Compliance
Researchers examined compliance among 100 of the nation's largest hospitals
by bed count and found

65% 22% 53%

65 were 22 hospitals 53 of the 65 failed

"unambiguously appeared compliant to post payer-specific
noncompliant" negotiated rates

False Claims Act (FCA)

1

Imposes civil liability submission of fraudulent claims.

A physician knowingly bills for patient services when the patient
was not seen.

Physician Self-Referral Law (Stark Law)

2

Prohibits a physician from making referrals to an entity for certain

healthcare services.
The physician owns a pharmacy and only writes prescriptions for
their Medicare patients for which the patient must go to the
physician’s pharmacy.

Anti-Kickback Statute (AKS)

3

Prohibits transactions intended to induce or reward referrals.

A medical office gives gift certificates to a popular coffee shop to
patients who bring (refer) other patients to the office to see the doctor.

HIPAA (Privacy and Security)

4

Establishes a national set of security standards for protecting certain

electronic health information.
Exposing patient data to a third party or refusing to provide patients
with copies of their medical records.