As a physician who files claims through Medicare, there is pertinent information you need to know about the Medicare False Claims act. The False Claims Act allows for the prosecution of individuals who commit fraud against the United States government. Most physicians believe they are not at risk for committing Medicare fraud. However, it is crucial to understand the act in order to protect yourself from liability.
Are you a physician who files claims to Medicare for services you provide? There are 4 facts you should know about the Medicare False Claims Act:
#1. It is always illegal to misrepresent a service or product supplied to a patient in a Medicare claim.
In some cases, physicians believe they are acting out of benevolence, falsely diagnosing patients to allow them access to further coverage under Medicare. Whether or not the intention was to commit fraudulent activity in order to obtain government funds, it is never acceptable to misrepresent a service or product supplied in a Medicare claim.
#2. You may be liable for your employees’ actions.
If someone in your billing department or another employer bills for a service or product that wasn’t provided or upcodes a service, you may be liable for their actions. This is because you are the person receiving the fraudulently obtained government funds. Also, it is your responsibility to supervise the employees you hire.
#3. Accepting gifts or kickbacks of any kind is prosecutable under the False Claims Act.
If a vendor of any kind offers you incentive for your using their product, or attempts to use kickbacks to bias you towards their product, this is consider to be illegal under the False Claims Act. Never accept gifts of any kind of pharmaceutical companies or medical supplies.
#4. It is illegal to retaliate against whistleblowers.
Have you been found liable for fraudulent activity committed in your workplace? Then you can be further prosecuted if you retaliate against the person who reported your fraudulent actions. Therefore, it is crucial that you treat all of your employees fairly. Never terminate or punish someone engaging in whistleblowing activity.
In order to create an ethical workplace, you can encourage in-house whistleblowing among your employees. Reward employees for practicing transparency and honesty in the workplace. If an issue of any kind arises, do not try to conceal it. Instead, quickly report any fraudulent activity by the employees working for you in order to protect yourself from liability. An experienced whistleblower attorney can you protect yourself and your patients against complaints like this.
Have questions about the Medicare False Claims Act? Call the Bothwell Law Group at 770.643.1606.
Last year was a record year for False Claims Act penalties, and 2015 is pacing similarly so far. As the year draws to a close, it has become clear how seriously the government is dealing with organizations and corporations who involve themselves in fraudulent activity. In fact, in 2015, we saw two of the largest settlements under the False Claims Act—each one right around $500 million.
In essence, a false claim is any knowing claim or statement that is false and made for the purpose of defrauding another, or conspiring with another to do so. The False Claims Act (31 U.S. C. secs 3729-3733), or “Lincoln Law” is a federal statute that imposes liability on those who attempt to defraud governmental programs. These cases arise both in the pursuit of payment from governmental programs and the avoidance of payment rightfully owed to governmental programs.