Medical Billing and Contracting LiabilitiesCornell Course

While healthcare involves a noble mission, it is nonetheless a business, and just like any other business operation, there is a potential for fraud. In this course, you will focus on what are commonly called fraud and abuse laws. You will discover the legal protections for the doctor-patient relationships in state law, such as doctor-patient confidentiality, as well as the doctor's fiduciary duties to the patient. At the federal level, you will examine fraud and abuse statutes that carve out particular types of transactions with profit motives to penalize. These are transactions where providers submit false claims to the government for payment and where providers receive kickbacks in exchange for ordering care or making referrals.

As you progress, you will examine the liability your organization can face under the False Claims Act, including medical billing and physician contracting. You will also examine the definition of a kickback and the penalty for receiving one. In addition, you will explore safe harbors that allow practices that could be construed as anti-kickback violations but are protected from penalty because they could benefit a patient's healthcare overall.