False Claims Act (FCA)

regulated fraud associated with military contractors selling supplies and equip. to the Union Army;used by federal agencies to regulate conduct of any contractor that submits claims for payment to the fed. government (e.g., Medicare)

Federal Anti-Kickback Law

protects patients and federal healthcare programs from fraud and abuse by curtailing the corrupting influence of money on healthcare decision(ex.stop political action groups and drug companies from giving millions of dollars to politicians)

Implemented to protect the privacy of individuals in info. systems maintained by fed. gov. hospitals (e.g., military hospitals) and to give individuals access to records concerning themselves (Forerunner for HIPAA)

Physicians at Teaching Hospitals (PATH)

audits implemented by DHHS that examine the billing practices of physicians at teaching hospitals

Stark II Physician Self-Referral Law

physician self-referral laws (referrals for durable medical equipment, clinical laboratory services, physical therapy services, etc.)Hospitals must comply with these laws because of relationships they extablish with physicians

National Correct Coding Initiative (NCCI)

Developed by CMS to reduce Medicare program expenditures by detecting inappropriate codes on claims and denying payment for them. Medicare enforces this!(Correct Coding)

Health Insurance Portability and Accountability Act (HIPAA)

Mandated administrative simplification regulations that govern privacy, security, and electronic transaction standards for healthcare info.;Amended ERISA and COBRA; Created the Healthcare Integrity and Protection Data Bank; Established the progrm (MIP)

Payment Error Prevention Program (PEPP)

Initiated by DHHS to require facilities to identify and reduce improper Medicare payments and, specifically, the Medicare Payment error rate;Established Clinicial Data Abstracting Centers, now called QIO's

Tax Relief and Health Care Act of 2006 (TRHCA)

Created Physician Quality Reporting Initiative (PQRI) system that establishes a financial incentive for eligible professionals who participate in a voluntary quality reporting program

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Chapter 5

FEDERAL LAWS-PG. 99

Question	Answer
False Claims Act (FCA)	regulated fraud associated with military contractors selling supplies and equip. to the Union Army;used by federal agencies to regulate conduct of any contractor that submits claims for payment to the fed. government (e.g., Medicare)
Federal Anti-Kickback Law	protects patients and federal healthcare programs from fraud and abuse by curtailing the corrupting influence of money on healthcare decision(ex.stop political action groups and drug companies from giving millions of dollars to politicians)
Privacy Act of 1974	Implemented to protect the privacy of individuals in info. systems maintained by fed. gov. hospitals (e.g., military hospitals) and to give individuals access to records concerning themselves (Forerunner for HIPAA)
Physicians at Teaching Hospitals (PATH)	audits implemented by DHHS that examine the billing practices of physicians at teaching hospitals
Stark II Physician Self-Referral Law	physician self-referral laws (referrals for durable medical equipment, clinical laboratory services, physical therapy services, etc.)Hospitals must comply with these laws because of relationships they extablish with physicians
National Correct Coding Initiative (NCCI)	Developed by CMS to reduce Medicare program expenditures by detecting inappropriate codes on claims and denying payment for them. Medicare enforces this!(Correct Coding)
Health Insurance Portability and Accountability Act (HIPAA)	Mandated administrative simplification regulations that govern privacy, security, and electronic transaction standards for healthcare info.;Amended ERISA and COBRA; Created the Healthcare Integrity and Protection Data Bank; Established the progrm (MIP)
Payment Error Prevention Program (PEPP)	Initiated by DHHS to require facilities to identify and reduce improper Medicare payments and, specifically, the Medicare Payment error rate;Established Clinicial Data Abstracting Centers, now called QIO's
Tax Relief and Health Care Act of 2006 (TRHCA)	Created Physician Quality Reporting Initiative (PQRI) system that establishes a financial incentive for eligible professionals who participate in a voluntary quality reporting program

Created by: Tina Everett

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