Read the hypothetical case study carefully. What are the legal and/or compliance issues raised by
the hypothetical.
- What law, regulation, or governance requirement/policy MAY have been violated?
Consider among the following and explain why a potential violation may have occurred.
(Choose and explain which ones apply to the case)
• Federal False Claims Act
• Physician Self-Referral “Stark” Law
• Federal Anti-Kickback Statute
• Federal Tax-Exempt Law
• Emergency Medical Treatment and Labor Act (EMTALA)
• Health Insurance Portability and Accountability Act (HIPAA)
• Antitrust Law
• Good governance (e.g., Sarbanes-Oxley)
• Organizational bylaws
• Standards of conduct/conflicts of interest policy
• Scope of practice laws, licensure, certification
• Employment law, corporate liability - Which issues merit highest priority? Why?
- Which issues would you recommend for further investigation? Why?
Sample Solution
• Anti-Kickback Statute
The potential violations that may have occurred in this case are the Federal False Claims Act and the Anti-Kickback Statute. The Federal False Claims Act makes it illegal for individuals to knowingly make false statements or submit false claims to obtain government funds. In this case, Dr. Smith could be accused of falsely claiming services he did not provide in order to receive higher payments from Medicare and Medicaid.