Categories of Fraud, Waste, and Abuse Laws

In the United States, laws aimed at fraud, waste, and abuse are adopted at both the Federal and State level. Federal fraud, waste, and abuse laws often (but don’t exclusively) concern governmentally sponsored health plans, such as Medicare, Medicaid, and Military Benefits. State fraud, waste, and abuse laws can apply to commercial insurance and individual consumers, but these can vary significantly between states. Private disputes between insurance carriers and dentists are also generally governed by state law.

Fraud, waste, and abuse laws generally apply to billing practices, marketing efforts, and the structures of business ventures/investments. Fraud, waste, and abuse laws are complex, and can often apply to one or all three of these categories simultaneously. For example, a “refer a friend” marketing effort, overseen by a dental marketing company, could potentially implicate a federal prohibition on kickbacks, a state fee-splitting prohibition, and run afoul of other state laws governing the corporate practice of dentistry.