Most physicians strive to provide high-quality medical care to patients and submit authentic documents for taxation and reimbursement claims to the federal government. However, even ethical practitioners, businesses, and corporations can sometimes face charges of violating the False Claims Act, despite conducting thorough due diligence. This may be due to negligence on their employees’ part, or discrepancy in the documentation submitted to governmental bodies.
Even in scenarios where the error is unintended, the allegations can cause serious damage to your/your practice’s reputation. If the charges are proven in court, you may be subjected to suspension and debarment, and the threat of civil and criminal penalties.
The False Claims Act is a federal statute that sets criminal and civil penalties for corporations and professionals falsely billing the government, over-representing the amount of a delivered product, or under-stating an obligation to the government.
This Act applies to healthcare providers and businesses that directly or indirectly work with the United States government on a contractual basis and are paid for their services by the government. Practitioners found guilty of performing fraudulent activities may be dealt with by the United States Department of Justice or by private individuals in a qui tam proceeding.
Read on to know about dealing with a False Claims lawsuit in an efficient manner.
1. Be Cautious When Choosing Your Business Partners
When appointing contractors for functions such as billing and transportation, you should be cautious about their credibility. Opting for genuine dealers and contractors for government projects can reduce the risk of fraud being committed. Remember that you will be held liable for any dubious activities of the contractors. Avoid working with anyone trying to maximize recoveries through claims, especially when the claim amount is far beyond the norm.
You may appoint an internal regulatory team to supervise third-party dealers. This team can ensure that the middlemen are aware of the government regulations regarding filing claims, and are following them diligently.
2. Steer Clear from Prospect Bribery
The False Claims Act pays special attention to businesses operating in the healthcare and defense fields. Such type of fraud is prevalent among Medicare and Medicaid providers, nursing homes, home healthcare providers, pharmaceutical companies, government grants, and research projects, weapons and defense contractors, environmental contractors, and low-income housing.
Cases, where practitioners are involved in bribery and illegal favors, are quite commonly reported in these sectors. You should reject any plausible freebies, offers, and benefits that could fall into the category of illegal incentives or rewards for patient referrals.
3. Have a Plan to Deal with Accusations of Fraud
In order to mitigate allegations of participating in fraudulent activities, businesses should mandate formal investigation as a policy. Your prompt actions and assistance during the investigation may work in your favor.
Try to arrange for witnesses who can vouch for your innocence. Showing the government that you are proactive in your approach may save you from debarment, loss of license to practice, or even a trial.
If you already have a policy in place that shows that you are mindful of the government regulations and comply with the law, then it may help your case.
4. Keep a Check on Cases of Up-coding Services
There have been numerous cases where the billing of government and private insurance programs has been wrongly calculated or stated by contractors. Complex series of codes are used to medical procedures and services provided by healthcare providers and entities. The federal government assigns a certain amount for each of the procedures/services, using numerical codes.
Up-coding or inflating figures are considered as a clear violation of the Federal False Claims Act. It can occur when a healthcare provider submits claims stating higher figures for the services provided. The claims for medical services, treatments, or diagnostic tests that you provided under the healthcare programs should not be wrongly recorded as more expensive than they were. You need to make sure that the medical billing assistants and other administrative staff use updated figures as mentioned by the government when filing claims.
5. Hire a Lawyer to Represent You
The intent of being party to fraud is a critical aspect in any False Claims Act case. If you can prove that misrepresentation of figures in your claims and invoices was unintentional, then the court may be lenient toward you.
These are tricky matters and require legal and diplomatic expertise that can be offered by a medical lawyer, who has a stronger hold on such cases. Hire legal counsel or independent auditors to review your company policies so that they can prove that you did not knowingly intend to defraud the government.
In case you are facing allegations, your attorney will be familiar with government contracts and can guide you through the investigation. Don’t fret if there are investigators at your workplace to go through your accounting documents. It is important that you cooperate with them and honestly follow the legal advice and document the actions and steps that are to be taken if you are facing allegations of fraud.
6. Develop Internal Practices to Reduce Oversight in Invoices and Claims
All businesses require multiple levels of reviewing before submitting claims and invoices to the Federal Government. Create a separate division in your company/healthcare department that looks into these matters and ensures authenticity in the numbers quoted in the documents.
You’re accounting and legal teams can assist the regulatory team to comply with the governmental standards, accounting principles, and Defense Contract Audit Agency (DCAA) requirements. You can even conduct regular audits to limit the chances of errors before the government officials spot a discrepancy.
Dealing with governmental contracts may require you to pay more attention to details than you usually would. You will be under more scrutiny and at a greater risk of damaging your business if you are convicted of performing fraudulent activities and cheating the government. There may be a possibility of unintentional oversight when filing claims for the work you have done. Opting for legal advice can help you handle the investigation and legal procedures, and avoid the embarrassment of being convicted of fraud.