This is Part Two of a two part program reviewing the federal False Claims Act and examines the False Claims Act in the context of Health Care. The program can be viewed separately and credit is provided for each individual program. It is suggested that the Part One be viewed first.
One of the interesting aspects of this program is the significant recoveries available to a private plaintiff under the Act and how a private plaintiff can merely ride along while the government prosecutes the action. This program will be of interest to attorneys in all practice areas due to the wide scope of the False Claims Act and the implications across many disciplines.
In part one, Mr. Dechene reviews the reimbursement backdrop, services that are typically paid by third party payors which are have limited or no involvement in the selection and provision of the underlying service; civil remedies for a private prosecution, penalties, encouraging submission of claims for non-covered services ; upcoding, false statements leading to FDA approval of drugs; false statements leading to cms coverage decisions; and, use of inaccurate billing codes to enhance reimbursement.
In part two, Mr. Dechene examines failure to deliver quality care; how federal law separately regulates quality; enforcement by survey deficiency reports and plans of correction; failure to correct or gross and flagrant can lead to administrative penalties or exclusion; failure to refund overpayments; false certification of compliance; defenses; statute of limitations and seal period; and the divergence between cases and settlements. |
