Amendments To The False Claims Act Can Help Consumers Reap Millions As Whistleblowers
The new healthcare law recently passed by Congress and signed by president Obama includes significant changes and expansions of the federal False Claims Act (“FCA”), making it easier for whistleblowers to file a claim and potentially earn millions of dollars helping the government fight healthcare fraud.
In one of its more significant false claims provisions, the healthcare reform law imposes an explicit duty on physicians to return known overpayments to the government within 60 days of discovering an error. Retaining an overpayment beyond that deadline could constitute a false claim. Because the 60-day window is a short one, doctors should analyze their claims on a regular basis.
Moreover, the new healthcare bill states that anti-kickback violations can also give rise to false claims liability. And when it comes to anti-kickback claims, the government is no longer required to prove that a physician or another claimant had a specific intent to violate the law, making it easier for the federal government to prosecute. And because a wide range of activities could be considered kickbacks -- from discounts to referral fees to marketing practices -- medical providers should scrutinize their arrangements with other health care entities.
Most importantly, pursuant to the new healthcare bill, whistleblowers are given more opportunities to help root out fraud and the healthcare bill eliminates the “original source” requirement of the False claims Act. The health reform law now allows whistleblowers to initiate false claims actions based on information already publicly disclosed through state or local administrative reports or proceedings, such as a state Medicaid audit. In other words, a whistleblower no longer has to be the original source of the information to be able to use those additional facts to help build a case. The amendments to the healthcare bill effectively nullified a March 30 Supreme Court decision, Graham County Soil v. U.S., that held the so-called public disclosure bar was intended to limit a whistleblower's ability to use secondhand information to generate false claims cases.
In sum, the health system overhaul includes changes to the federal False Claims Act and other anti-fraud statutes that:
· Require physicians to return overpayments within 60 days of discovering a payment error;
· Make it easier for the government to use anti-kickback violations as the basis for a false claims suit;
· Allow whistleblowers to initiate lawsuits based on certain publicly disclosed information;
· Permit physicians to self-disclose potential Stark violations; and
· Allows the Centers for Medicare & Medicaid Services (“CMS”) the discretion to reduce repayment amounts for Stark violations.
If you are aware of Medicaid and/or Medicare fraud being committed against the United States government by a city, doctor, hospital, clinic, pharmacy and/or medical supply company, you may be entitled to a multi-million dollar award. You can help hardworking taxpayers from being cheated -- and earn millions of dollars in the process -- by blowing the whistle on Medicaid and Medicare fraud.
If you know or suspect that Medicaid and/or Medicare fraud is being committed anywhere in the country, please contact us to discuss your legal options.
