VII. Key Issues: Regulation & Reform >> B. Health Care Regulation >> Health Professionals Regulation >> Fraud and Abuse Regulation (last updated 1.4.16)
Fraud and abuse regulation includes federal and state statutes and regulations related to deterring, detecting and prosecuting fraud and abuse as it relates to health professionals. The Duke Center for Health Policy and Inequalities Research has developed a draft working paper assessing the costs and benefits of fraud and abuse regulations (P2-Fraud-Abuse).
- Centers for Medicare and Medicaid Services. Open Payments. “Sometimes, doctors and hospitals have financial relationships with health care manufacturing companies. These relationships can include money for research activities, gifts, speaking fees, meals, or travel. The Affordable Care Act requires CMS to collect information from applicable manufacturers and group purchasing organizations (GPOs) in order to report information about their financial relationships with physicians and hospitals. Open Payments is the federally run program that collects the information about these financial relationships and makes it available to you. View the summary data dashboard for an overview of the published data.”
- ProPublica. Dollars for Docs. ProPublica’s Dollars for Docs database contains approximately $4 billion in payments to doctors, other medical providers and health care institutions that have been disclosed by 17 pharmaceutical companies and their subsidiaries since 2009. ProPublica took these disclosures and assembled them into a single, comprehensive database that allows patients to search for their physician or medical center and receive a listing of all payments matching that name. The database can also be searched by state and by company. It can be filtered by category and by year.
- U.S. Chamber, Institute for Legal Reform. Fixing the False Claims Act: The Case for Compliance-Focused Reforms, October 23, 2013.
- U.S. Chamber, Institute for Legal Reform. The Great Myths of State False Claims Acts: Alternatives to State Qui Tam Statutes. October 23, 2013.
- U.S. Chamber, Institute for Legal Reform. The Exclusion Illusion: Fixing a Flawed Health Care Fraud Enforcement System. October 24, 2012.