Information Regarding Federal and State False Claims Acts
The Federal False Claims Act (FCA) states the liability for individuals who file or cause to be filed false or fraudulent claims. In addition, many states have enacted state false claims acts which are similar to the Federal FCA. DCI is committed to deterring fraud, waste, and abuse within the company and complying with all Federal and state regulations. Through its compliance program, DCI has implemented policies and procedures to prevent the filing of false claims. Additionally, DCI has established methods for reporting suspected false claims to the Compliance Officer, including confidential and anonymous methods. Details of DCIs compliance program are contained in the Corporate Policy & Procedure Manual, the DCI Intranet (http://intranet.dciinc.org), and in your annual compliance training. Below, DCI has outlined important provisions relevant to you which are contained in the Federal False Claims Act (FCA). In addition, many states have enacted state false claims acts or related acts which contain provisions similar to the FCA. Complete texts and/or summaries of the Federal and state false claims acts, as well as links to the relevant Federal and state websites, are listed below and on subsequent pages.
Important Provisions of the Federal False Claims Act
The Federal False Claims Act provides, in pertinent part, that:
(a) Any person who (1) knowingly presents, or causes to be presented, to an officer or employee of the United States Government or a member of the Armed Forces of the United States a false or fraudulent claim for payment or approval; (2) knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Government; (3) conspires to defraud the Government by getting a false or fraudulent claim paid or approved by the Government;. ... or (7) knowingly makes, uses, or causes to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the Government, is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages which the Government sustains because of the act of that person . . . .
(b) For purposes of this section, the terms "knowing" and "knowingly" mean that a person, with respect to information (1) has actual knowledge of the information; (2) acts in deliberate ignorance of the truth or falsity of the information; or (3) acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required. 31 U.S.C. 3729.
While the False Claims Act imposes liability only when the claimant acts "knowingly," it does not require that the person submitting the claim have actual knowledge that the claim is false. A person who acts in reckless disregard or in deliberate ignorance of the truth or falsity of the information, also can be found liable under the Act. 31 U.S.C. 3729(b).
In sum, the False Claims Act imposes liability on any person who submits a claim to the federal government that he or she knows (or should know) is false. An example may be a physician who submits a bill to Medicare for medical services she knows she has not provided. The False Claims Act also imposes liability on an individual who may knowingly submit a false record in order to obtain payment from the government. An example of this may include a government contractor who submits records that he knows (or should know) are false and that indicate compliance with certain contractual or regulatory requirements. The third area of liability includes those instances in which someone may obtain money from the federal government to which he may not be entitled, and then uses false statements or records in order to retain the money. An example of this so-called "reverse false claim" may include a hospital who obtains interim payments from Medicare throughout the year, and then knowingly files a false cost report at the end of the year in order to avoid making a refund to the Medicare program.
Whistleblower protections for Qui Tam relators
In addition to its substantive provisions, the FCA and many state acts provide that private parties may bring an action on behalf of the government. These private parties, known as "qui tam relators," may share in a percentage of the proceeds from a FCA action or settlement.
Section 3730(d)(1) of the FCA provides, with some exceptions, that a qui tam relator, when the Government has intervened in the lawsuit, shall receive at least 15 percent but not more than 25 percent of the proceeds of the FCA action depending upon the extent to which the relator substantially contributed to the prosecution of the action. When the Government does not intervene, section 3730(d)(2) provides that the relator shall receive an amount that the court decides is reasonable and shall be not less than 25 percent and not more than 30 percent.
The FCA and many state acts provide protection to qui tam relators, also known as whistleblowers, who are discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of their employment as a result of their furtherance of an action under the FCA. Remedies include reinstatement with comparable seniority as the qui tam relator would have had but for the discrimination, two times the amount of any back pay, interest on any back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys fees.
DCIs procedures to report potential false claims violations
DCIs Compliance Program prohibits the preparation or submission of any false or fraudulent claims. If you encounter any situation which that you believe might violate a Federal or state law or regulation, or any provision of DCIs Policies and Procedures, you should immediate report your concerns to your immediate supervisor or to the DCI Compliance Officer. Such reports may be made to an employees supervisor or to the Compliance Officer. Reports may be made to the Compliance Officer: (1) in writing to Dialysis Clinic, Inc., 1633 Church Street, Suite 500, Nashville, TN 37203; (2) via email at email@example.com; or (3) through DCIs Compliance Hotline at (877) 326-1109. All correspondence to the Compliance Officer will be treated confidentially. Reports may be conducted anonymously - written reports do not need to be signed and you are not required to identify yourself in a telephone report.
DCI prohibits retaliation or retribution of any kind against a person who, in good faith, makes any report regarding actual or potential compliance violations and who was not involved in the misconduct. Any person, including any manager or supervisor, who is found to have engaged in, or condoned, an act of retaliation against an individual in response to a good faith report of a suspected or actual violation will be subject to discipline, up to and including termination.
General codes are links to the home page of websites that contain all or significant parts of federal or state codes.
False Claims Acts are laws passed by state governments regarding the submission of false claims to a government entity for payment. These acts may be Medicaid specific or cover claims against all state government entities and sometimes against private healthcare insurers.
Qui tam actions are actions in which a private citizen, called a "relator," initiates an action on behalf of the government in return for which the relator will receive some part of any award or settlement received by the government.
Whistleblower protection laws provide varied levels of protection for employees who report their employers misconduct or who participate in an investigation against their employer.
Penalties for false claims may be found in False Claims Acts but may also be found under other sections of the code.
In addition general fraud laws exist in most states. The requirements are often different from False Claims laws but these laws may also apply to false claims. Links to these statutes are not generally provided on this site.
False Claims Laws - State Laws
For state False Claims Law resources, click on the links that follow each state:
General Code :. (For False Claims and Penalties: Go to Title 25.5 Health Care Policy and Financing, Article 4 Colorado Medical Assistance Act, Part 3 Recovery Sections 25.5-4-304 to 25.5-4-306.)
Other Criminal Provisions:
General Code :. (For False Claims: Go to Title 49, Chapter 4, Article 7B)
General Code :. (For False Claims: Go to Title VI Human Services, Subtitle 6 Children and Families, Chapter 249A, section 249A.7)
General Code :. (For
Medicaid False Claims Act go to Chapter 27 - Public Assistance, Article 14
Medicaid False Claims Act) :. (For Fraud Against Taxpayers Act: Go to
Chapter 44 Miscellaneous Civil Law Matters, Article 9 Fraud Against
General Code :. (For False Claims: Go to State Finance, Article 13) :. (For Health Care Fraud: Go to Penal, Part 3, Title K, Article 177) :. (For Whistleblower Protection: Go to Labor, Article 20-C)
General Code (Limited) :. (For False Claims: Go to Title 62 P.S. Poor Persons and Public Welfare, Chapter 1 Public Welfare Code, Article XIV Fraud and Abuse Control) :. (For Whistleblower Protection: Go to Title 43 P.S. Labor, Chapter 25 Whistleblower Law)
General Code :. (For False Claims for to Title 71 · Welfare, Chapter 5 Programs and Services for Poor People, Part 1 · Medical Assistance Act, Sections 181 185)
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