Identifying Fraud And Abuse Concerns in eHealth Commerce

As the pace of commerce and communications over the Internet grows, buyers and sellers, as well as the intermediary organizations that facilitate transactions between buyers and sellers, must be careful not to engage in transactions that violate fraud and abuse laws. By "fraud and abuse" we refer generically to a number of federal and state laws, including the following¹:

• Anti-kickback laws
prohibit the payment, receipt, offer or solicitation of remuneration in exchange for the referral, recommendation or generation of healthcare goods and services. Generally, remuneration is defined broadly to include any direct or indirect economic benefit, including kick-backs, discounts, rebates, relief from financial obligations (such as interest-free loans), gifts and gratuities. Commonly accepted business practices such as preferential pricing on bundled goods and services, providing rebates based on volume, below cost pricing, free goods and services, and compensation based on percentage