What Can Be Done for Violating Federal Healthcare Laws?

May 22, 2023 - 9:03 pm - 4 min read

Federal healthcare laws are designed to protect patients and ensure that healthcare providers offer high-quality services while observing ethical and legal standards. These laws regulate various aspects of healthcare, including insurance coverage, health information privacy, medical malpractice, and Medicare and Medicaid fraud. Although most healthcare providers strive to comply with these laws, violation of federal healthcare laws can occur. This article discusses the consequences of violating federal healthcare laws and what can be done to address such violations.

Consequences of Violating Federal Healthcare Laws

Violating federal healthcare laws can result in severe consequences, including hefty fines, criminal charges, lawsuits, and debarment from participating in federal healthcare programs. The following are some of the consequences of violating federal healthcare laws:

Monetary fines: Providers who violate federal healthcare laws risk significant civil monetary penalties, ranging from $5,000 to $100,000 per violation depending on the nature and severity of the offense. They may also be required to pay back any improperly paid Medicare or Medicaid funds, which can result in substantial repayments.

Exclusion from federal healthcare programs: Providers who violate healthcare laws risk exclusion from federal healthcare programs such as Medicare, Medicaid, and the Children’s Health Insurance Program. For instance, the Office of Inspector General (OIG) can exclude providers who perpetuate fraud, abuse or otherwise engage in unethical conduct from federal healthcare programs for a minimum of five years.

Criminal charges: Providers who engage in fraudulent and abusive activities such as submitting false claims or kickbacks may face criminal charges and prosecution. Criminal charges may lead to imprisonment or probation, depending on the gravity of the offense.

Lawsuits: Patients or their family members can sue healthcare providers for violating their rights, causing harm, or wrongful death, among other claims. Such lawsuits may lead to monetary awards, settlements or judgments against the provider.

What Can Be Done to Address Violations of Federal Healthcare Laws?

Violating federal healthcare laws can have far-reaching consequences on both the healthcare industry and the patients they serve. As such, it is important to address such violations appropriately. The following are some of the actions that can be taken to address violations of federal healthcare laws:

Vigilance: Healthcare providers should be vigilant in ensuring that they comply with all applicable healthcare laws. They should be aware of the law’s changing landscape, remain up to date with regulatory developments and strive to avoid engaging in fraudulent, abusive or unethical practices.

Self-disclosure: Providers who suspect that they may have violated federal healthcare laws should consider self-disclosure as a remedial action. Self-disclosure involves voluntarily reporting any improper conduct to relevant authorities, such as the OIG, to avoid or reduce the potential penalties for the offense.

Cooperate with investigations: Providers who are under investigation for violating federal healthcare laws should cooperate fully with the relevant authorities. They should provide any requested information and documents without delay and in good faith.

Consult legal counsel: Providers who suspect that they may have violated healthcare laws or who are under investigation should seek legal advice from attorneys with experience in healthcare law. A healthcare attorney can provide guidance on how to minimize the risks associated with violations of healthcare laws and represent the provider during investigations.

Implement corrective actions: Providers who are found to have violated federal healthcare laws should implement corrective actions to prevent the recurrence of the offense. Such actions may include improving internal controls, retraining staff, or terminating contracts with any business associates who may have contributed to the violation.

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The consequences of violating federal healthcare laws can be severe. Healthcare providers who engage in fraudulent, abusive, or unethical activities risk hefty civil monetary penalties, criminal charges, lawsuits, or exclusion from federal healthcare programs. However, by being vigilant, reporting any improper conduct, cooperating with investigations, seeking legal advice, and implementing corrective actions, healthcare providers can minimize the risks of violating healthcare laws. Additionally, patients should take an active role in advocating for their rights and being vigilant about the quality and legality of the care that they receive.


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