Health Care Fraud Enforcement Arsenal

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Introduction The issue that many healthcare administrators seem to miss these days is what is currently happening behind the scenes when their hospital’s doctors are filing claims. This issue is very important to address considering your healthcare staff could be filing claims illegally to the Center for Medicaid and Medicare (CMS), and be subjected to the False Claims Act (FCA). Administrators need to make sure claims are filed correctly and not for the benefit of the doctors own pocket. Healthcare providers need to take caution and be aware of this situation occurring in their own hospital, as all healthcare organizations could be subjected to the False Claims Act. The Federal Claims Act is “one of the most powerful tools in the…show more content…
(2009).) Administrators of a healthcare facility “must also take into consideration that FCA violations can create barriers to their participation in government programs, such as Medicare and Medicaid. Exclusion from these programs could be devastating to organizations that generate significant revenues from those sources.” (Mattie, A., & Rosalyn Ben-Chitrit. (2009).). The issues of the False Claims Act have been brought to the public’s attentions under “qui tam actions”. These actions are a “public partnership with private individuals and congress, who closely observe or were involved in fraud. As part of the partnership agreement, the private individuals bringing suit on behalf of the government were entitled to a portion of the monetary damages recovered as a “bounty.” (Estrada) Current stakeholders such as CMS, private funding, public, and other government agencies will not take claims being filed illegally lightly. They are the ones who are loosing money in the process. The False Claims Act is being addressed to the upmost seriousness by the United States government towards the healthcare facilities.
History and Background The False Claims Act if you are not aware “is a government act that is targeted at individuals and entities that defraud or try to defraud the federal government including any federal programs.”(Mattie, A., & Rosalyn Ben-Chitrit. (2009).) Health care fraud accounts for up to 10 percent of total health care expenditures and costs
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