In April 2010, Reed Smith provided an extensive analysis of the recently-enacted health reform legislation, H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as amended by H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (Reconciliation Act). Together, these sweeping measures expand access to health insurance (including subsidies, mandates, and market reforms); reduce health care spending (particularly in the Medicare program); expand federal fraud and abuse authorities and transparency requirements; impose new taxes and fees on health industry sectors; and institute a variety of other health policy reforms.

In this analysis, we concentrate on those provisions in the new law that will affect Fraud Abuse and Program Integrity Provisions. These include changes to the federal False Claims Act, the Anti-Kickback Statute, and the Civil Monetary Penalty laws. In addition, we discuss the statutory predicates for upcoming anticipated regulations, including new transparency provisions and mandatory compliance programs.

Many of the new provisions require the Secretary of the Department of Health and Human Services (HHS) to issue implementing regulations, and we will be reporting on these developments in the coming months.

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