CMS Pub. 100-18, ch. 9, App. A

For more information on topics discussed in this chapter, including developing and

implementing effective compliance and fraud and abuse plans, see:

Government Resources:

1. National Benefit Integrity MEDIC:

http://www.healthintegrity.org/html/contracts/medic/index.html

2. Stop Medicare Fraud:

http://www.stopmedicarefraud.gov

3. The Patient Protection and Affordable Care Act:

http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW­

111publ148.pdf

4. Compliance Guidance for Medicare+Choice Organizations:

http://oig.hhs.gov/fraud/docs/complianceguidance/111599.pdf

5. Office of the Inspector General, Compliance Program Guidance for the

Healthcare Industry:

http://oig.hhs.gov/compliance/compliance-guidance/index.asp

6. Federal Sentencing Guidelines:

http://www.ussc.gov/Guidelines

7. Fraud Alerts, Bulletins and Other Guidance from the OIG:

http://oig.hhs.gov/compliance/alerts/index.asp

8. False Claims Act:

http://www.justice.gov/jmd/ls/legislative_histories/pl99-562/pl99-562.html

9. Health Insurance Portability and Accountability Act (HIPAA):

http://aspe.hhs.gov/admnsimp/pl104191.htm

10. Anti-Kickback Statute (see section 1128B(b)):

http://www.ssa.gov/OP_Home/ssact/title11/1128B.htm#f

11. Stark Law (Physician Self-Referral):

https://www.cms.gov/PhysicianSelfReferral/

12. TRICARE Fraud & Abuse:

http://www.tricare.osd.mil/fraud

Other Resources:

1. Health Care Administrators Association (HCAA):

http://www.hcaa.org/

2. Heath Care Compliance Association (HCCA):

http://www.hcca-info.org

3. Society of Corporate Compliance and Ethics (SCCE):

http://www.corporatecompliance.org

4. American Health Lawyers Association (AHLA):

http://www.healthlawyers.org

5. National Health Care Anti-Fraud Association (NHCAA):

http://www.nhcaa.org

6. Institute for Health Care Improvement (IHI):

http://ihi.org

7. Corporate Responsibility and Health Care Quality – A Resource for Health

Care Boards of Directors, U.S. Dept. of Health and Human Services Office of

the Inspector General and The American Health Lawyers Assn.:

http://oig.hhs.gov/fraud/docs/complianceguidance/CorporateResponsibilityFi

nal%209-4-07.pdf

Links to OIG and GSA Exclusions Databases

• OIG LISTSERV via the OIG Website: http://exclusions.oig.hhs.gov/

• General Services Administration (GSA) database of excluded individuals/

entities: https://www.epls.gov/