Coding component important element of compliance plan.

In recent years the U.S. government has increased its fraud and abuse investigations in all sectors of the healthcare community. Healthcare providers that are successfully prosecuted may be excluded from the Medicare programs and are liable for monetary penalties. The best course of action is for providers to have a comprehensive compliance plan in place. An important element of such a plan is a component that will identify and address problematic coding issues.

Mixing oil and water: the government's mistaken use of the Medicare anti-kickback statute in False Claims Act prosecutions.

In 1996, billing integrity generated a great deal of debate and litigation in the health care arena. Significantly, the federal government views a violation of the Anti-Kickback Act as a basis for a False Claims Act action. While federal courts are split on the issue, the author strongly contends that using the False Claims Act to do what the Anti-Kickback Act was intended to do is inappropriate, given Congress' intention in enacting each legislation.