Federal Laws and Regulations
Health Services Finance
05/08/2016

Federal Laws and Regulations
The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded directly, in whole or in part, by the United States Government or any state healthcare system.
What are five elements pertaining to the establishment of a false claim under the False Claims Act?
Under whatever section of the Act, the government or a qui tam plaintiff must prove the following: (1) that the defendant presented or caused to be presented to the United States government a claim for payment or approval, or a document to facilitate the payment of a false claim; (2) that the claim and/or document was false or fraudulent; and (3) that the defendant knew that the claim was false or fraudulent or acted with reckless disregard of the truth or falsity of the claim. If these elements are present, a violation of the FCA occurs even if the government never actually makes any payment or suffers a financial loss. The defendant does not have to act with a specific intent to defraud in order to be liable, as long as the submission was "knowing."
HIPAA privacy standards were designed to accomplish what three broad objectives?
The HIPPA privacy standards are intended to accomplish three broad objectives: define the circumstances in which protected health information may be used and disclosed, establish certain individual rights regarding protected health information, and require that administrative safeguards be adopted to ensure the privacy of protected health information.
What are 10 specific designated health services (DHS) for which referrals by