ipl-logo

False Claims Act Vs FCA

1426 Words6 Pages

Question I:
Healthcare fraud is intentionally deceiving, providing false statements, or misrepresentation in order to obtain an unauthorized benefit through billing Federal/State insured agencies e.g. Medicare or Medicaid. Fraudulent activity involves the act of knowingly, willfully, and intentionally committed or committed the act with reckless disregard.
False Claims Act (“FCA”) prohibits knowingly presenting or causing to be presented a false claim for payment of government funds. Penalties can include criminal, civil and administrative consequences.: 18 U.S.C. § 287 Criminal prosecution/imprisonment, Civil - 31 U.S.C. §§ 3729-3733 suspension of payments, exclusion from participation in federal health care programs for 5 years or more, …show more content…

In the case of US cs. MedQuest Associates, the court held that MedQuest violated FCA though 1) use of non-Medicare approved physicians for contrast studies testing and 2) use of the physician’s number without reporting the change in ownership to Medicare. These two acts lead to hefty fines. However, the US Court of appeals found in favor of the defendants when they ruled that claimant 's use of non-approved supervising physicians for contrast procedures, and subsequent submission of claim for Medicare payment, did not constitute adequate basis for FCA claim under implied false certification theory; and claimant 's use of Medicare billing number belonging to physician 's practice that it controlled did not trigger hefty fines and penalties created …show more content…

Physicians in the US are given the autonomy to prescribe to patients without restriction of drug indication as long as the prescribe drug is given to the patient to help with their ailment in good faith. Physicians give the prescription to the patient to get filled in the pharmacy. The retail pharmacist does not have instant access to their medical records to verify the indication. The pharmacist can verify the drug and the intent of the phycisian. Once confirmed, the pharmacist can fill the prescription regardless of efficacy of the drug on the patient. It is a stretch to implicate the physician for false claims in off label prescribing because the physician is writing the prescription, not submitting the claim. The pharmacist is the person submitting the claim, however they are filling the prescription based on the physician’s intent and good

Show More
Related
732 Words | 3 Pages

St. David’s South Austin Medical Center (the “Hospital”) has received a letter from John Craven, an attorney representing former Hospital patient Ramona Reeves. Mr. Craven states that the Hospital’s entering into a Settlement Agreement with GEICO Insurance Company after the Hospital’s receipt of Ms. Reeves’ “HIPPA (sic) Revocation/Cancellation of Prior Authorization” constituted a wrongful disclosure of her individually identifiable health information (“PHI”). You have asked us to evaluate whether the provision of billing information and/or entering into the settlement agreement with GEICO violated HIPAA. The answer is no.

Read More
506 Words | 3 Pages

A Bordentown family physician’s license was temporarily suspended for prescribing up to 720 opioid pain pills a month without any physical exams or documentation of a legitimate need for the drugs, according to the Division of Consumer Affairs. The physician, Dr. Moishe Starkman, allegedly prescribed large amounts of Fentanyl, Oxycodone, and similar drugs to five patients over the course of five years. From 2012 to 2017, he wrote them prescriptions without legitimate reasons until he agreed to a suspension of his license until a hearing on the allegations with the state Board of Medical Examiners, according to the New Jersey Attorney General’s press release. “We allege that instead of providing legitimate medical care to his patients, Dr. Starkman simply wrote them prescription after prescription for highly addictive drugs without so much as taking their temperature,” Attorney General Porrino said.

Read More
579 Words | 3 Pages

An EMTALA Case Mary Carnahan HA 301 Legal Aspects Legislation in Health Care March 17, 2016   Introduction This research paper is about a case law for a federal appellate circuit for an EMTALA case. Describe the case and the EMTALA requirement(s) at issue. How does it relate to the professional standards a medical professional must follow?

Read More
434 Words | 2 Pages

Pharmacists are in a unique position to help. They have the ability and knowledge to implement programs as part of their daily practice to ensure that patients are adherent to their medications. As the medication experts, pharmacists should lead the way to improving medication adherence and providing optimal patient care. The provisions of this bill do not pose a mandate but where appropriate would require the proration of prescriptions, related cost sharing, and dispensing costs in order to conform the patient to one monthly refill that occurs on the same date each month.

Read More
469 Words | 2 Pages

A doctor should always take into consideration what is best for their patients without being influenced by anyone. In Stephanie Saul’s article “Drug Makers Pay for Lunch as they Pitch” she discusses how pharmaceutical companies use free lunches as an incentive to influence Doctors to prescribe their brand drugs. Many see this situation of pharmaceutical companies purchasing meals for a Doctor’s entire office as not having any effect on the doctor’s decision to prescribe their brand. The reality is that these free lunches do influence a doctor to prescribe a certain brand drug when writing a patient’s prescription. A doctor should consider what is the best option for a patient something that is affordable and if the case is that a name brand drug is the best option it should not be influenced by the pharmaceutical company in any way.

Read More
1502 Words | 7 Pages

The Stark law is a federal law, which was named after Pete Stark, a former congressman that created the law to prohibit physicians or doctors from referring patients to institutions where the doctors have a financial gain or relationship. The patients, however, must be Medicare patients. The relationship addressed, in this case, implies any financial relationship as a consequence of ownership or whether the doctor acquires financial compensation from referring the patient to the institution. The same law can also be examined under the physician referral law, which is stipulated in the Social Security Act, section 1877. Management Responsibility and Violation Consequences

Read More
540 Words | 3 Pages

These breaches and failure to comply with the rules can be detrimental to the healthcare organization and most importantly the patients. The Privacy Rule applies to “covered entities” which generally includes health plans and health care providers who transmit health information. Covered entities include almost all health and mental health care providers (NYS, n.d). Therefore, whether the healthcare organization is inpatient, outpatient, residential provider or

Read More
752 Words | 4 Pages

Retrieved from https://www.gpo.gov/fdsys/pkg/USCOURTS-mied-2_14-cr-20273/pdf/USCOURTS-mied-2_14-cr-20273-6.pdf United States vs. Trotter and Lovett demonstrated how liability extends beyond a provider when Lovett, the owner of the billing company, was convicted of Medicare fraud and abuse. This case exemplifies how all workers within a healthcare system can be liable for the misuse of Medicare funds. Because of this, understanding the laws and regulations by healthcare workers is critical to ensure they are properly enforced. Government Publishing Office. (2018).

Read More
1369 Words | 6 Pages

The Health Insurance Portability and Accountability Act (HIPAA) is a vital part of the health care industry’s day to day business. HIPAAs procedures define how healthcare companies receive and handle their clients’ health care information. HIPAA helps to protect the patient’s personal information through confidentiality and security procedures while being transferred, handled or shared with other healthcare providers (Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules, 2013). When a patient’s privacy is not regulated, third parties could buy and sell the information without the patients’ authorization. With HIPAA being in place, it prevents healthcare employees from divulging any patient information they

Read More
283 Words | 2 Pages

The doctrine is commonly used to show to whom a defendant—usually a prescription drug manufacturer—owes the duty to adequately warn. The doctrine bars a plaintiff’s claims if she cannot show that the allegedly inadequate warning was a producing cause of her injury. Relators argued that the learned intermediary doctrine does not apply to claims under the FCA. Specifically, Relators argued that SPI cannot rely on the learned intermediary doctrine because there is no causal connection between the warnings given by the prescribing physicians and the alleged FCA violations. SPI, on the other hand, argued that, at trial, Relators should be forced to account for the role of the learned intermediary.

Read More
398 Words | 2 Pages

Lying and cheating are dishonest behavior that can get you in trouble. In health care the state has set up a law on personal gain. You cannot ask for, or accept monetary gain over a certain amount to improve your business. It is called the anti-kickback statute (AKS). (hhs.gov pg,4) “The AKS is a criminal law that prohibits the knowing and willful payment of “remuneration” to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients.”

Read More
301 Words | 2 Pages

These changes allow healthcare professionals to reap huge financial benefits for reporting Medicare fraud that is done by the healthcare industry. In some cases, people have been rewarded millions for reporting Medicare Fraud. People who report Medicare fraud are now able to receive up to 30 percent of the fines that are collected by the government. They are also able to receive full protection from retaliation. Hundreds of millions of dollars have been paid out by the United States government to people who have reported information about Medicare fraud.

Read More
797 Words | 4 Pages

The Federal and State governments share the cost of Medicaid. Fraud, waste, and abuse in Medicaid drain taxpayer dollars and cause improperly high payment rate. Modern Healthcare reported (2015) that in 2014, the government reported nearly $80 billion misspent on Medicaid and Medicare. New York City is an example of local government struggling with Medicaid fraud; New York Times (2005) suggests that 40 percent of NYC’s Medicaid payments are “questionable”. Most of the reporting protocols are optional, and because reporting information consumes already-limited resources, many states choose not to report.

Read More
628 Words | 3 Pages

Researchers built a survey about pharmacists and provided willingness to dispense medications that sometimes conflict with religious doctrine, 668 pharmacists participated in this survey, 13.2% of pharmacists in total 85 pharmacists stated clearly that they would refuse to dispense at least one medication but are willing to transfer the prescription to another pharmacist, and another 4.5% in total 29 pharmacists stated clearly that they would refuse to fill two or more medications but are willing to transfer them to another pharmacist. There are many pharmacists refusing to dispense medication such as contraception, but willing to transfer the prescription to somewhere else, which is shown in this survey. Area or personal religion beliefs should not affect any patients medication needs. According to the results of the survey, even though many pharmacists stated that they do refuse to dispense medication, they are willing to transfer the prescription to another pharmacist. Therefore, patients should be allowed to choose which pharmacist they prefer, thus meet their medication

Read More
448 Words | 2 Pages

Medical insurance is a vital part of people’s lives. Without medical insurance it would be hard for most people to afford to go to a doctor for treatment. Not only the cost of paying out of pocket fees for medical insurance but also for deductibles. You can also commit fraud very easily if you are not aware of how to properly fill out an application for medical insurance. There are also many different types of medical insurances that you can apply for, and compare prices if you are having to pay out of pocket expenses.

Read More

More about False Claims Act Vs FCA

Related Topics

Open Document