The False Claims Act

The False Claims Act is a piece of legislation from the U.S. Congress that allows any individual with knowledge of a fraud being perfected against any agency of the U.S. Government to file a claim on behalf of the Government against the individual or business that has or is committing such fraud. The individual filing such claim on behalf of the United States Government is identified as the qui tam plaintiff and, if the action is successful, such person is entitled to share in a percentage of the

False Claims Acts (FCA) Also known as  "Lincoln Law“. One of the most grounded informant procurement in the United States. Permits private parties to file qui tam actions claiming that defendants defrauded the government (False Claims Act Overview, 2016). FCA History It was implemented during the Civil War to fight and prevent the extortion executed by organizations that sold supplies to the Union Army. President Abraham Lincoln supported the False Claims Act.  The Federal False Claims Act covers

Proprietary education dates back to the late nineteenth century where institutions focused on professional training in teaching, medicine, and law (Breneman, Pusser, & Turner, S., 2000). The 1972 Higher Education Reauthorization Act included for-profit institutions in federal financial aid programs and changed the vernacular of higher education to postsecondary education (2000). This piece of legislation along with new technologies along with increased demand for higher education and prompted a resurgence

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

Off-label promotion: profitable health jeopardizing act of defiance or costly freedom of speech? INTRODUCTION Over the years there is the discussion on the nature of off-label promotion. Promotion for an unapproved by the Food and Drug Administration usage of a drug, medical device or biologic is prohibited by the 1938 Food, Drug and Cosmetics Act, and subjects the product to the misbranding provisions. On the other hand, off-label promotion is deemed to be a constitutional right protected by the

five elements pertaining to the establishment of a false claim under the False Claims Act are the government must establish that the claim submitted is false and that it was submitted knowingly, the government must establish that the person submitted the claim with actual knowledge, in deliberate ignorance, or with reckless disregard for the claim’s truth or falsity, the claim was against a department or agency of the United States and if the claim was material. Privacy Standards were designed to

specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).” In 1989, Congress enacted the Ethics in Patient Referrals Act. Commonly known as Stark law, Congress named it in honor of Rep. Pete Stark, a Democrat from California, and original sponsor of the bill (Sprague 2004). This law places limitations on self-referrals by physicians

Labor Law Whistle Blowing Dillema Labor relations today, are quite different from those that existed in England during the eighteenth and nineteenth centuries when employment relationships were considered of very little importance in the eyes of the law. Industrialization and commerce grew bringing with it the birth of modem day labor law. America was in no way exempt from the pain of progress. Employer and employee relationships were strained from the very beginning of labor, and it

Introduction 3 1.2 Policies and Procedures 4 1.3 Duties of the Employee 4 2 Essential Guidelines of the Compliance Plan 2.1 Assuring Quality 5 2.2 Patients’ Rights 5 2.3 Anti-Kickback and Self-Referral Laws 6 2.4 False Claim Act 7 3 Compliance Plan Establishment 3.1 Director of Compliance Role 7 3.2 Education and Training 8 3.3 Ongoing Oversight 8

established in part due to the Patient Protection and Affordable care Act (ACA). (Nesbitt, 2017) The False Claims Act (FSA) allows recovery of funds from anyone who knowingly presents a fraudulent claim to the government. (Nesbitt, 2017) Financially, recovery for fraudulent claims can be very expensive with penalties of $5,000 to $11,000 per claim. (Nesbitt, 2017) In some cases, criminal charges can apply for falsifying health care claims. (Nesbitt,