1. Aside from cost control to prohibit trust, several statutes have been passed to control.
2. Stark Law (I and II)
a. These prohibit doctors from owning health care facilities to which they refer patients whose bill is paid by Medicare or Medicaid.
b. No investment or renumeration interest.
3. Prosecution of Medicare fraud and abuse
a. The principal are of investigation is in billing.
b. CPT are the 1500 common procedures.
c. The doctor must justify the submission with a form 1500 and list the code for the procedure for which he will bill.
4. Note?Medicare is federal funded.
5. Medicaid is both state and federal funded.
6. The HCFA, Health Care Financing Administration has been changed to the CMS that is essentially the same thing. Under CMS, a private citizen for a person receiving federal funds may bring a qui tam action. Ordinarily, this is not allowed, but there is special standing.
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