The Patient Protection and Affordable Care Act amended the AKS to state that a billing or claim "resulting from" a violation of the Statute constitutes a false or fraudulent claim under the FCA. However, this amendment did not clarify when a claim "resulted from" a violation of the AKS. ...
“where the service is not actually rendered to the patient, is already provided under another claim, is upcoded, or is not supported by the patient’s medical record.”[61]To ensure compliance with the FCA, the guidance recommends that entities take “proactive measures . . . including ...
If a whistleblower’s FCA lawsuit is successful in returning money to the government, then the Healthcare, Government Contracts and Grant is generally eligible for a financial reward – usually between 15% and 30% of the amount recovered. False Claims Act laws also prohibit whistleblower ...
First, the false claim needs to be perpetrated against a Federal, State or Government agency. Secondly, the culprit needs to knowingly attempt to defraud the government. Once these are proven severe civil penalties will be enforced. What Healthcare Fraud Looks Like Example #1: Medicare and ...
Among these were: * Expanding the definition of one defrauding the government to include those who do so without specific intent (in addition to willful defrauders); * Including individuals or companies that cause someone else to submit a false claim as a defrauder; * Clearer rules for ...
The total includes approximately $3.2 billion in settlements stemming from the opioid crisis, including the $2.8 billion claim that Purdue agreed to allow in its bankruptcy “to resolve civil allegations that the company promoted its opioid drugs to health care providers it knew were prescribing ...
In these cases, the submitting party is a third-party entity, such as a healthcare provider, whereas the actual defendant in the case is an entity, such as a drug manufacturer, that causes the third party to submit a false claim. Regarding these cases, courts have found that such third-...
taking steps to determine whether the claim is false, or is aware of a substantial and unjustifiable risk that the claim is false but submits it anyway, the scienter element for a violation under the FCA would be met and the pharmacy or healthcare provider has submitted a false claim. ...
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 su...
(x) liability under the False Claims Act; (y) a claim for price adjustment under the Cost or Pricing Data Act; or (z) any other request for a reduction in the price of any Current Government Contracts, including, without limitation, to claims based on actual or alleged defective pricing....