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date: 13 December 2017

Abstract and Keywords

This chapter examines the effect of increased healthcare integration on the longstanding problem of healthcare fraud in the United States. The chapter begins with an overview of the concepts of fragmentation and integration within the context of the healthcare reform envisioned by the Patient Protection and Affordable Care Act (ACA). The discussion then turns to the key healthcare fraud and abuse laws that may pose barriers to provider integration, including the Medicare and Medicaid Anti-Kickback Statute, the Ethics in Patient Referrals Act (Stark Law), and the civil monetary penalties provisions. After analyzing the characteristics of various forms of integration, the chapter considers the core question: whether integration will necessarily reduce healthcare fraud.

Keywords: healthcare, integration, healthcare fraud and abuse, fragmentation, healthcare reform, Patient Protection and Affordable Care Act, Medicare and Medicaid Anti-Kickback Statute, Ethics in Patient Referrals Act, civil monetary penalties

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