The Federal False Claims Act is a law that imposes liability on a person or a company who intentionally makes a false claim regarding any health care program or tries to defraud the federal government. As a health care executive, physician or other health care provider, you should be very concerned about the potential for the government to use the Anti-Kickback Statute as one of the prime methods for enforcing the FCA, the primary enforcement tool used by the Justice Department. It is also concerning that, along with Stark II (the federal physician anti-referral law), the Anti-Kickback Statute can be and is being used as the basis for an action brought under the FCA.
The following are considered to be unlawful under this act:
- When a false claim is knowingly presented for approval or payment, or caused to be so
- When a false record or statement amounting to a fraudulent or false claim is made or caused to be made
When a conspiracy is made for committing a violation of any provisions of the False Claims Act
- When the amount or kind of property meant for use by the government is falsely valued or certified
- Not ascertaining the truth of information contained in a document relating to the certifying receipt of property is also unlawful according to the Federal False Claims Act
- Willful purchase of government property from an unauthorized officer of the government
- When false records are made or used or caused to be made or used with the intention of avoiding or decreasing the legally obliged payment or transmit property to the government knowingly, this is also considered unlawful by the Federal False Claims Act
- No good faith or actual knowledge standard for compliance
- Penalty is denial of Medicare or Medicaid payment and, in three situations, civil monetary penalties and exclusions
- Review of the Provider-Based Rule (PBR)
- Where a person knows or should know that an improper claim has been made or where a refund has not been made (penalty of up to $15,000 for each prohibited service provided);
- where a person knows or should know that the purpose of the arrangement is to circumvent The Stark Law (penalties of up to $100,000 for each scheme);
- For false reporting under The Stark Law (penalty not to exceed $10,000 per day).
- Voluntary disclosures and private whistleblower actions.
- Defendants are at mercy of judges
Provisions for Qui tam plaintiff or Relators
This law allows a person employed by the company accused in the suit to file action against that organization on the behalf of the government. This is called whistle blowing where the person is not personally injured. And the person doing so is called a whistleblower or a relator or qui tam plaintiff.
Qui tam means suing on behalf of oneself while suing for the government. Such people are also called relators in this act. The Federal False Claims Act allows such people to receive 15 to 25 percent of the recovered damages.
After reporting a violation, the relator might face unfair treatment in the organization or he might get terminated from his service, so for protecting him from all of this, he may also be awarded:
- Two times of their back pay plus interest.
- Reinstatement of their position without loss of seniority.
- Compensation for any costs or damages they incurred.
For complete and better understanding of the False Claim Act, Stark and Anti-Kickback Statute, join us on our live webcast ‘Stark, Anti-Kickback & The False Claim Act‘ on March 5, 2019.