The Tennessee Attorney General (AG) has filed a lawsuit against a health services management organization and mobile dental services company for violations of the Tennessee Medicaid False Claims Act. The complaint alleges that the health services management organization knowingly caused false claims to be submitted under the stateās Medicaid program.
The lawsuit claims that the Defendants focused on Tennesseans who were receiving Medicaid assistance for their long-term care and were eligible to deduct healthcare expenses, including dental care, from the payment to their long-term care facility. The deduction resulted in Tennesseeās Medicaid program paying for a larger portion of the long-term care charges.
The health services management organization and the mobile dental service company provided free administrative services to the long-care facilities and free dental services for some of their residents. In exchange, the long-term care facilities referred patients to the health services management organization. This act resulted in an illegal kickback arrangement.
In addition, a second violation occurred when the health care organization referred those same residents to the mobile dental service company, in return for cash.
The lawsuit states that these actions violated the federal Anti-kickback Statute, which in turn violates the Tennessee Medicaid False Claims Act. The State is seeking damages to be determined at trial, in addition to the maximum civil penalty for each violation.
Issue:
It is extremely important that all members of the healthcare team are aware of what may be considered a false claim or a kickback. Ensure that all staff are aware that these violations can occur whether they are intentional or not intentional. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 2 Financial Integrity, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points:
- Review policies and procedures for preventing and reporting a false claim or anti-kickback statute violations. Update your policies and procedures as needed.
- Train all staff on the False Claims Act and Anti-Kickback Statute and what can be considered a false claim or kickback. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employeeās education file.
- Periodically audit staff to ensure that they are aware of what should be done if they suspect a false claim or illegal kickback has occurred, whether intentionally or unintentionally. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim.
FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
