Yes, healthcare providers that do not bill Medicare or Medicaid may still be subject to the same regulations as healthcare providers that do bill Medicare or Medicaid. This is because there are a number of laws that apply to all healthcare providers, regardless of whether they bill Medicare or Medicaid.
One of the most important laws that apply to all healthcare providers is the Medicare and Medicaid Patient Protection Act of 1987, which is also known as the Civil Monetary Penalties Law. This law provides for civil penalties for a variety of fraudulent or abusive activities, including:
- Billing for services that were not provided.
- Upcoding, which is billing for a higher level of service than was actually provided.
- Kickbacks, which are payments made to induce or reward referrals of patients.
The Civil Monetary Penalties Law applies to all healthcare providers, regardless of whether they bill Medicare or Medicaid. This means that a healthcare provider that provides services to self-pay patients may still be subject to civil penalties under the law if it engages in any of the fraudulent or abusive activities listed above.
In addition to the Civil Monetary Penalties Law, there are a number of other laws that may apply to healthcare providers that do not bill Medicare or Medicaid. These laws include:
- The Anti-Kickback Statute
- The Stark Law
- The False Claims Act
- The Health Insurance Portability and Accountability Act (HIPAA)
These laws are designed to protect the Medicare and Medicaid programs from fraud, waste, and abuse. By understanding these laws and taking steps to comply, healthcare providers can help to protect themselves from penalties and ensure that they are providing high-quality care.
Additional resources that you may find helpful:
- The Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov/
- The Office of Inspector General (OIG): https://oig.hhs.gov/
- The American Medical Association (AMA): https://www.ama-assn.org/
- The American Hospital Association (AHA): https://www.aha.org/
For questions or concerns, contact us via the following:
- Chatbox window on your Complete Compliance Suite screen.
- Telephone: 877-560-4261
- Email: support@epicompliance.com