The past two conferences have included even more lectures and information related to the latest revisions of Medicare reimbursement requirements and what anesthesiologists and their practice managers should do to be in compliance in the event of an audit by any Medicare agency. This past year's seminar also included significant information about the increase of audits by the Inspector General's office and the financial penalties being levied as a result of alleged fraudulent billing. On review of this monograph, the ASA Administrative Council determined to contract with the law firm for an expanded version to contain significant information on how practices should develop compliance programs and internal audits. This document will be edited by legal experts, anesthesiologists and anesthesia practice managers and should be available to ASA members by late summer. In many cases, state laws contain similar provisions.
Fraudulent activities can result in both criminal and civil liability.
Abuse is a lesser offense that refers to incidents and practices that are inconsistent with accepted medical practice and result in unnecessary cost or financial loss, directly or indirectly, to the Medicare program, e.g., claims for services that were not medically necessary. Abuse can escalate into fraud, especially where the abusive conduct is repeated until it is discovered. False Claims Liability A series of laws bars the submission of false claims to the government. They, too, provide for both criminal and civil liability. Enforcement of the False Claims Act is not limited to government officials.