This course provides an understanding of the laws related to healthcare fraud and abuse in United States. The three major fraud and abuse statues – the False Claims Act, the Stark Law and the Anti-Kickback Statute – will be covered in detail. This includes identifying the statutory construction of each of these three statutes and seeing how different courts have applied them. Related subjects to be covered include, an overview of Federal and State agencies tasked with eliminating fraud and abuse in the healthcare arena, examples of settled and litigated cases and their impact on the healthcare industry and the history and ongoing evolution of healthcare fraud and abuse enforcement.
For information regarding prerequisites for this course, please refer to the Academic Course Catalog.
Federal and state healthcare laws have increased exponentially due to increased government healthcare expenditures. These laws often impose crippling monetary and criminal penalties on those engaged in delivering healthcare services, and thereby necessitate industry understanding of their scope and reach. Healthcare providers are presumed to know and understand these complex and ever-changing laws.
Textbook readings, case law, videos, and lecture presentations.
Course Requirements Checklist
After reading the Course Syllabus and Student Expectations, the student will complete the related checklist found in the Course Overview.
Discussions are collaborative learning experiences. Therefore, the student is required to create a thread in response to the provided prompt for each discussion. Each thread must be at least 400 words, demonstrate course-related knowledge, and be supported by at least 2 scholarly sources cited in proper Bluebook format. In addition to the thread, the student is required to reply to 2 classmates’ threads. Each reply must be at least 200 words.
Market v. Government Paper Assignment
For this assignment, you will write a 1200–1500-word paper on the topic “Should the Government or the Market Regulate Healthcare?” The paper must contain at least 5 references to outside scholarly sources in addition to citing the course textbook and the Bible. Each paper must adhere to current Bluebook formatting and graduate level writing standards.
Healthcare Fraud and Abuse Paper Assignment
The student will choose a topic in the field of healthcare fraud and abuse and write a research-based paper on the topic selected. This assignment is broken down into 3 parts:
Healthcare Fraud and Abuse Paper: Topic Proposal Assignment
The student will write a 750-word proposal for the Healthcare Fraud and Abuse Paper. The proposal will include the specific topic for the paper, thesis statement, and 10 preliminary scholarly sources from within the last 10 years. The proposal must adhere to current Bluebook formatting.
Healthcare Fraud and Abuse Paper: Annotated Bibliography Assignment
The student will identify 10 scholarly sources relevant to the legal, moral, biblical, and ethical implications of the definition of personhood. The student must prepare an annotation of 150 words for each of the 10 sources. The sources here may be used for the Healthcare Fraud and Abuse Paper: Final Assignment. This assignment must adhere to current Bluebook formatting.
Healthcare Fraud and Abuse Paper: Final Assignment
Based on the topic outlined in the proposal and the feedback from the instructor, the student will write a 3,500–4,500-word research paper. The paper must include at least 20 scholarly references in addition to the course textbook and the Bible. This assignment must adhere to current Bluebook formatting.