Healthcare Billing Fraud Targeted by the Government
A new committee has been formed by the HHS and US Attorney General that will also stand to strengthen the provisions that allow for whistle blowers to share in the recovered funds. With the new laws going into effect, we could stand to see a higher level of lawsuits filed.
Durable medical equipment in the home has been the targeted area for fraud for many years. If a hospital was overpaid by Medicare a few years back and did not repay the money, the could be liable, and this stands to go back a few years, so when analyzing any payments made, it may not be a bad idea to double check the number if in doubt.
Also as part of the package, the attorney general can delegate the authority to make civil investigative demands to lower level government lawyers, so less legal cost for government attorneys if it can be held at a local level in civil courts.
In addition, there are some additional pending amendments that could or could not be added.
With scant money in the federal budget available to overhaul the way healthcare is provided and paid for in the U.S., the Obama administration and Democratic leaders in Congress would like their hands on tens of billions of Medicare and Medicaid dollars lost each year to fraud and abuse.
The government often relies on whistle-blowers and the False Claims Act to get at more complicated and subtle forms of fraud and abuse, and in healthcare allegations are often based on violations of the anti-kickback statute and the restrictions on physician self-referral known as the Stark Law. The Justice Department credits the False Claims Act with returning $14.3 billion to HHS since 1986, when Congress reinvigorated the Civil War-era statute.
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