Health Care Reform Enhances Fraud and Abuse Laws


The Patient Protection and Affordable Care Act (H.R. 3590), signed into law on March 23, 2010, contains new fraud and abuse provisions. Some of the key fraud and abuse provisions include:

Requires all providers to implement compliance programs. The U.S. Department of Health and Human Services (HHS) will develop core elements for inclusion in a compliance program.

Requires providers to report and return overpayments within 60 days of identifying the overpayment (or the date any corresponding cost report is due). Providers must state in writing the reason for the overpayment. Clarifies that an overpayment retained after the deadline for reporting and returning the overpayment is an “obligation” for purposes of the False Claims Act (FCA). Under the FCA, any provider who knowingly retains an overpayment can face civil prosecution.

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