A Georgia district court has issued a summary judgment against a state rehabilitation center for 808 false claims billed to Medicaid and Tricare between November 2015 and June 2020. The false claims included physical and speech therapist treatments supposedly provided by individuals no longer employed at the facility.
In analyzing the question of whether the rehabilitation center knowingly submitted the false claims, the court found that the center’s conduct “epitomizes ‘reckless disregard’ of the truth.” The court found that the center’s submission of 767 claims to Medicaid and Tricare over an eight-month period following the resignation of one physical therapist, and the submission of 41 claims following the resignation of a speech therapist, could not be characterized as an “honest mistake.”
The court has ordered the parties involved to appear within 30 days for a hearing on the issue of damages. The hearing is scheduled for May 2, 2022.
US Attorney Peter D. Leary stated, “Protecting the integrity of our nation’s healthcare programs that provide critical services for veterans, elderly, and vulnerable people is imperative to ensure the continued good health of these very programs. Our office will pursue reports of medical facilities that file false claims, a choice that ultimately robs our citizens.”
Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. 2, 2015–July 31, 2016, and a range of $11,181–$22,363 for violations committed after Jan. 29, 2018.
Issue:
All submitted claims must be accurate and truthful. It is important for staff to be aware that false claims can occur whether they are intentional or unintentional. Additionally, failure to promptly report a false claim can result in lawsuits, fines, and other sanctions. A robust compliance and ethics program can help identify false claims therefore reducing fraud, waste, and abuse of government funds.
Discussion Points:
- Review your policies and procedures for operating an effective compliance and ethics program to ensure that identifying false claims is included. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually. Additionally train all staff on what can be considered a false claim. Members of the compliance committee should periodically receive training on compliance and ethics in healthcare. Document that these trainings occurred, and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of compliance and ethics concerns and understand their responsibility to report any violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
