Applicable Laws

Question 1

What does FCA stand for?

Answer 1

False Claims Act

The FCA is a federal law that imposes liability on individuals and companies who defraud governmental programs.

Question 2

What is a key term associated with the False Claims Act?

Answer 2

‘Knowingly’ submitting a ‘false or fraudulent claim’

This implies that the person submitting the claim is aware it is false or fraudulent.

Question 3

What must be proven under the FCA for a claim to be actionable?

Answer 3

The claim must be ‘material’ to the payment of ‘government funds’

Materiality refers to the significance of the claim in influencing the government’s payment decision.

Question 4

What is the ‘qui tam’ provision in the FCA?

Answer 4

A provision for whistleblowers

This allows individuals to sue on behalf of the government and share in any recovery.

Question 5

What does AKS stand for?

Answer 5

Anti-Kickback Statute

The AKS is a federal law aimed at preventing healthcare fraud and abuse.

Question 6

What does the Anti-Kickback Statute prohibit?

Answer 6

The ‘offer, pay, solicit, or receive’ of ‘remuneration’

This is specifically in exchange for referrals of services or items payable by a federal healthcare program.

Question 7

What is the intent required under the AKS?

Answer 7

‘Induce or reward’ referrals

The AKS focuses on the intent behind the remuneration, which must be to influence referrals.

Question 8

What are ‘safe harbors’ in the context of the AKS?

Answer 8

Protections for certain legitimate arrangements

Safe harbors allow specific practices that would otherwise violate the AKS to be exempt from liability.