When healthcare providers and other government contractors are subject to scrutiny for bills submitted to the government, it is often the result of a whistleblower complaint filed under the qui tam provisions of the False Claims Act.
But what if the healthcare provider or government contractor identifies potential fraud against the government on its own – for example, through an internal compliance audit or hotline call?
In that scenario, the company may be well advised to consider a self-disclosure. This post provides a primer on the various self-disclosure options and how they work.
Perhaps the most straightforward way to address potential billing misconduct is to repay or refund the affected funds to the relevant government agency or program. For example, a healthcare provider might refund Medicare payments directly to a Medicare Administrative Contractor. Participants in the Medicare program are required to return identified overpayments within 60 days under 42 U.S.C. § 1320a-7k(d).
While this option has the benefit of simplicity and may allow a company to avoid providing detailed information about why it believes a repayment is necessary, it does little to resolve potential liability. For example, a repayment will not affect potential liability for treble damages and civil monetary penalties under the False Claims Act. Nor does it preclude administrative liability under the Civil Monetary Penalties Law. Repayment also does little to...
A federal jury has convicted a San Francisco man of conspiracy, wire fraud, and money laundering in connection with a scheme involving fraudulent insurance claims on already-wrecked vehicles, pros...