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A roadmap for new physicians: Avoiding Medicare and Medicaid fraud and abuse

Catherine Boerner ( is President of Boerner Consulting, LLC inNew Berlin, WI.

Do you give all your physicians a copy of the OIG’s “A Roadmap for New Physicians”? Every time I review the compliance resources and training given to physicians at credentialing and re-credentialing, I always recommend that this document is included. It’s available at

It states in the introduction under the “Fraud & Abuse Laws” section:

The five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL)…. As you begin your career, it is crucial to understand these laws not only because following them is the right thing to do, but also because violating them could result in criminal penalties, civil fines, exclusion from the Federal health care programs, or loss of your medical license from your State medical board.

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