Providers: Partners in the Fight against Fraud
Most physicians work ethically, provide high-quality medical care, and submit proper claims for payment. Trust is at the core of the physician-patient relationship.
The federal government also places enormous trust in physicians. Medicare and other federal health care programs rely on physicians’ medical judgment to treat patients with appropriate services. When reimbursing physicians and hospitals for services provided to program patients, the federal government relies on physicians to submit accurate and truthful information.
The presence of some dishonest health care providers who exploit the health care system for illegal personal gain has created the need for laws that combat fraud and abuse and ensure appropriate quality medical care.
Complying with anti-fraud laws
For information on compliance with health care fraud laws, see Compliance 101 from the Department of Health and Human Services (HHS) Office of Inspector General (OIG).
The Centers for Medicare and Medicaid Services (CMS) helps physicians understand how to comply with federal laws by identifying “red flags” that could lead to potential liability in law enforcement and administrative actions. Read Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians (PDF - 1.1 MB).
CMS uses the Medscape platform to provide education to physicians on compliance. To access each of the programs below, you will need to create a Medscape account.
- Reducing Medicare and Medicaid Fraud and Abuse: Protecting Practices and Patients
- How CMS Is Fighting Fraud: Major Program Integrity Initiatives
OIG also offers compliance training. Materials include videos, audio podcasts, webcasts, slides, and numerous documents.
Protecting your practice against fraud
Protecting your medical practice against health care fraud is important too. CMS provides training on safeguarding your medical identity (PDF - 140KB).