Amendments To The False Claims Act. July 7, 2009
|
|
- Alaina Norman
- 8 years ago
- Views:
Transcription
1 1 Amendments To The False Claims Act July 7, 2009
2 2 About this Webcast Need both browser & Webex open Rejoin webcast: Follow link in Event number: Event password: Cfca2009 Rejoin call: Conference call number: Communicate/Teleconf. Send questions via chat or Q & A to All Panelists Problems? paulab@ethics.org
3 3 Participants Moderator: Peter Hutt Partner, Akin Gump Strauss Hauer & Feld Robert Rhoad Partner, Crowell & Moring Jeb White President, Taxpayers Against Fraud Tony R. Maida Deputy Chief, Administrative and Civil Remedies Branch, Office of Counsel to the Inspector General, U.S. Department of Health and Human Services
4 4 What are we talking about? Civil False Claims Act, 31 U.S.C et seq. amended by Congress in the Fraud Enforcement and Recovery Act of 2009 ( FERA ). Legal landscape also includes: Fraud against health benefit programs, 18 U.S.C Criminal penalties for false statements or representations under federal health care programs, 42 U.S.C. 1320a-7b(a) Reporting obligations under government contracts and Federal Acquisition Rules (including new obligation to report if knowledge of significant overpayment) State false claims acts
5 5 Unchanged basics False claims submitted for government payments prohibited Severe sanctions: Treble damages Penalty of up to $11,000 per violation Many violations can result from single error or scheme Private qui tam civil suits brought on behalf of government Separate statutes for civil and criminal enforcement
6 6 What do amendments change? Liability expanded to clearly include false claims submitted for payment to government contractors and grantees Strengthened reverse false claim exposure on amounts due to government Adding materiality requirement Expanded conspiracy liability Relating back authority to help government beat statute of limitations More retaliation protection for whistleblowers Reverses pro-defense court rulings Eases government ability to issue investigative demands Easier for government to share information with qui tam plaintiffs
7 7 Change to presentment requirement and addition of materiality element Softens presentment requirement Adds materiality requirement here
8 8 Changed definition of claim
9 9 Actionable false claims not limited to those presented to the United States Resolves conflict between prior need for presentment to the U.S. and the prior claim definition that includes those made to recipients of federal funds Overturns U.S. ex rel Totten v. Bombardier, where court held it was not enough for a claim to be presented to Amtrak even though all of its money came from the federal government Affects all subcontractors Change would more clearly bring false claims by providers to Medicare Advantage and FEHBP plans within FCA scope
10 10 Allison Engine overturned The Supreme Court had held that to be liable for using a false statement or record to get a false claim paid by the Government Requires proof that defendant intended that the claim be paid by the Government itself; It is not sufficient that Government funds were used to pay the false claim. Amendments reject Supreme Court s holding
11 11 Expanded reverse false claim exposure Lawyer Fuel: improperly... avoids... obligation... to the Government
12 12 What is an obligation? When can established duty arise from retention of any overpayment, other than from -- a contractual, grantor-grantee, licensor-licensee, fee-based or similar relationship, or a statute or regulation?
13 13 Reverse false claims stay tuned Reverse false claim When it becomes a false claim if you already have money you shouldn t have and you say nothing Amendment leaves for argument: Does it apply to amounts for which obligation is owed to government contractor, but not to the government itself? Implication of language hospital s false claim to Medicare Advantage Organization is actionable, but hospital s knowing concealment of accidental overpayment apparently is not What constitutes avoid[ing] payment? When is avoiding payment improper?
14 14 Material
15 15 Conspiracy liability strengthened
16 16 Clarified liability for failure to return it all
17 17 Government claims can relate back to filing of qui tam complaint
18 18 Attorney General can delegate authority to issue CIDs
19 19 Government ability to use CID information
20 20 New information-sharing provisions
21 21 Changed anti-retaliation provisions Contractors and agents now protected Protection to internal whistleblowers, not just qui tam filers
22 22 Whistleblower relief
23 23 Effective date
24 24 Perspectives from the HHS OIG I m from the Government and I m here to help
25 25 ACRB Role in FCA Cases ACRB role in all HHS FCA cases Qui tams: intervention/declination determination OIG subpoenas: review and approval process HHS Agency Counsel Exclusive authority to exercise permissive fraud exclusion 1128(b)(7) of Social Security Act (SSA) Exclusion releases only by OIG in writing
26 26 Permissive Fraud Exclusion 1128(b)(7), i.e. 42 USC 1320a-7(b)(7) Applies to anyone who submits false claims, violated the anti-kickback statute, bills while excluded, or otherwise violates the CMPL, 1128A, i.e. 42 USC 1320a-7a
27 27 ACRB Role in FCA Cases: Permissive Exclusion Criteria Circumstances of misconduct and seriousness of offense Defendant s response to allegations/ determination of unlawful conduct Likelihood that offense or similar abuse will occur again Financial responsibility
28 28 Corporate Integrity Agreements (CIAs) Required if exclusion released Contract between defendant provider and OIG entered into upon FCA/CMPL settlement Theory of CIA: continued participation with appropriate controls and oversight by OIG Five year term
29 29 CIA Requirements Compliance officer/committee Written code of conduct Written policies and procedures General and specific training Requirements for ineligible persons Independent audits and reviews Confidential disclosure program Notification of Reportable Events Annual reporting to the OIG Breach and Default provisions Stipulated penalties Exclusion for Material Breach if not cured
30 30 Preventative Medicine Robust compliance program Adoption by Leadership Education Effectiveness in uncovering issues Action on issues Tests of effectiveness
31 31 Compliance Resources Compliance Program Guidances Special Fraud Alerts and Bulletins Board of Directors OIG Work Plan and Semi-Annual Report Advisory Opinions Apply only to requestor, but informative
32 32 What to do? Provider Self-Disclosure Protocol Potential fraud or other violations Cooperation Timely Resolution Protocol available on the OIG website 2006, 2008, and 2009 Open Letters Presumption of no CIA if fully cooperate
33 33 Questions?
34 34 Additional Information Recording and presentation of webcast will be available to attendees free of charge. For more information, please contact Phil Smith Vice President/Communications ERC (571)
FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE
FEDERAL LAWS RELATING TO FRAUD, WASTE AND ABUSE FEDERAL CIVIL FALSE CLAIMS ACT The federal civil False Claims Act, 31 U.S.C. 3729, et seq., ( FCA ) was originally enacted in 1863 to combat fraud perpetrated
More informationUPDATED. OIG Guidelines for Evaluating State False Claims Acts
UPDATED OIG Guidelines for Evaluating State False Claims Acts Note: These guidelines are effective March 15, 2013, and replace the guidelines effective on August 21, 2006, found at 71 FR 48552. UPDATED
More informationCriminal Defense and Investigations
Fraud Enforcement and Recovery Act of 2009 SUMMARY On May 20, 2009, President Obama signed into law the Fraud Enforcement and Recovery Act of 2009 ( FERA ), a statute intended to strengthen the federal
More informationThe Nuances Of California s Revisions To Its False Claims Act
The Nuances Of California s Revisions To Its False Claims Act by Regina A. Verducci, Associate Watt, Tieder, Hoffar & Fitzgerald, L.L.P.* On September 27, 2012, California s Governor Brown signed Assembly
More informationUSC Office of Compliance
PURPOSE This policy complies with requirements under the Deficit Reduction Act of 2005 and other federal and state fraud and abuse laws. It provides guidance on activities that could result in incidents
More informationCompliance with False Claims Act
MH Policy and Procedure Document Number: MH-COMPLY-001 Document Owner: Corporate Compliance Officer Date Last Author: Corporate Compliance Officer General Description Purpose: To establish written guidelines
More informationOSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS
OSF HEALTHCARE FALSE CLAIMS PREVENTION AND WHISTLEBLOWER PROTECTIONS POLICY: CC-109 It is the policy of OSF HealthCare (OSF) that false, inaccurate or improper claims will not be submitted to any payer.
More informationState Medicaid FCA - A Lawyer's Perspective
May 15, 2012 New Law Extends Georgia False Claims Liability to Non- Medicaid Claims Significant Revisions Also Made to Existing State False Medicaid Claims Act Introduction On April 16, 2012, Georgia Governor
More informationSOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572
SOUTH NASSAU COMMUNITIES HOSPITAL One Healthy Way, Oceanside, NY 11572 POLICY TITLE: Compliance with Applicable Federal and State False Claims Acts POLICY NUMBER: OF-ADM-232 DEPARTMENT: Hospital-wide CROSS-REFERENCE:
More informationFALSE CLAIMS ACT PRIMER
FALSE CLAIMS ACT PRIMER HCCA Compliance Institute Sunday, April 29, 2012 I. Elements of a False Claims Act Violation A. A Direct (Affirmative) False Claim Most False Claims Act cases involve direct or
More informationAN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA To amend the District of Columbia Procurement Practices Act of 1985 to make the District s false claims act consistent with federal law and thereby qualify
More informationEDUCATION ABOUT FALSE CLAIMS RECOVERY
Type: MGI Corporate Policy Number: M 700 Effective Date: June 2014 Supersedes: AP 201, 4/12 Revised: 6/14 EDUCATION ABOUT FALSE CLAIMS RECOVERY I. PURPOSE This policy is intended to ensure compliance with
More informationTitle: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs. Area Manual: Corporate Compliance Page: Page 1 of 10
Title: Preventing and Reporting Fraud, Waste and Abuse in Federal Health Care Programs Area Manual: Corporate Compliance Page: Page 1 of 10 Reference Number: I-70 Effective Date: 10/02 Contact Person:
More informationNORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy
NORTHCARE NETWORK POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy RESPONSIBLE PARTY: Chief Executive Officer/Compliance Officer CATEGORY: Compliance BOARD APPROVAL
More informationThis policy applies to UNTHSC employees, volunteers, contractors and agents.
Policies of the University of North Texas Health Science Center 3.102 Detecting and Responding to Fraud, Waste and Abuse Chapter 3 Compliance Policy Statement UNTHSC developed and implemented a Compliance
More informationVILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL ORIGINAL EFFECTIVE DATE: JANUARY 1, 2007
VILLAGECARE CORPORATE COMPLIANCE POLICY AND PROCEDURE MANUAL SUBJECT: COMPLIANCE WITH FEDERAL AND STATE FALSE CLAIMS LAWS AND DETECTION AND PREVENTION OF FRAUD, WASTE AND ABUSE LAST POLICY REVISION EFFECTIVE
More informationVNSNY CORPORATE. DRA Policy
VNSNY CORPORATE DRA Policy TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005: POLICY REGARDING THE DETECTION & PREVENTION OF FRAUD, WASTE AND ABUSE AND APPLICABLE FEDERAL AND STATE LAWS APPLIES TO: VNSNY ENTITIES
More informationFalse Claims Act CMP212
False Claims Act CMP212 Colorado Access is committed to a culture of compliance in which its employees, providers, contractors, and consultants are educated and knowledgeable about their role in reporting
More information55144-1-5 Page: 1 of 5. Pharmacy Fraud, Waste and Abuse Policy. 1.0 Compliance Assurance. 2.0 Procedure
Pharmacy Fraud, Waste and Abuse Policy 1.0 Compliance Assurance This Fraud Waste and Abuse Policy ( Policy ) reiterates the commitment of this pharmacy to comply with the standards of conduct established
More information0 HealthAlliance. of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH
0 HealthAlliance of the ~udsoti vallevtm J / YOUR PARTNERS IN HEALTH Policy: Compliance with Applicable Federal and State False Claims Acts Initiated: January 1,2010 Reviewed: Revised: Reference: Responsible
More informationRobert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 KD_4901979
False Claims Act Update Robert A. Wade, Esq. Krieg DeVault LLP 4101 Edison Lakes Parkway, Ste. 100 Mishawaka, IN 46545 Phone: 574-485-2002 Email: bwade@kdlegal.com KD_4901979 1 The FCA is the Fraud Enforcement
More informationThe Fraud Enforcement and Recovery Act and Healthcare Reform: Implications for Compliance Initiatives and Fraud Investigations
The Fraud Enforcement and Recovery Act and Healthcare Reform: Implications for Compliance Initiatives and Fraud Investigations Presented by: Robert Threlkeld, Esq. Holly Pierson, Esq. Paul F. Danello,
More informationPrevention of Fraud, Waste and Abuse
Procedure 1910 Responsible Office: Yale Medical Group Effective Date: 01/01/2007 Responsible Department: Administration Last Revision Date: 09/20/2013 Prevention of Fraud, Waste and Abuse Policy Statement...
More informationUnderstanding Health Reform s
Compliance 101: Understanding Health Reform s New Compliance Requirements Uri Bilek Feldesman Tucker Leifer Fidell LLP Does your organization have a designated Compliance Officer? a. Yes b. No c. Don't
More informationA summary of administrative remedies found in the Program Fraud Civil Remedies Act
BLACK HILLS SPECIAL SERVICES COOPERATIVE'S POLICY TO PROVIDE EDUCATION CONCERNING FALSE CLAIMS LIABILITY, ANTI-RETALIATION PROTECTIONS FOR REPORTING WRONGDOING AND DETECTING AND PREVENTING FRAUD, WASTE
More informationfraud, waste, abuse, compliance, integrity, Integrity Help Line
Policy / Procedure: KEY TERMS: fraud, waste, abuse, compliance, integrity, Integrity Help Line I. PURPOSE: To help our employees, agents and contractors understand the methods to prevent and detect fraud,
More informationHow To Make A False Claims Law Work For The Federal Government
SB2730 TESTIMONY OF THE DEPARTMENT OF THE ATTORNEY GENERAL TWENTY-SIXTH LEGISLATURE, 2012 ON THE FOLLOWING MEASURE: S.B. NO. 2730, RELATING TO FALSE CLAIMS TO THE STATE. BEFORE THE: SENATE COMMITTEE ON
More informationPOLICY AND STANDARDS. False Claims Laws and Whistleblower Protections
POLICY AND STANDARDS Corporate Policy Applicability: Magellan BH (M) NIA (N) ICORE (I) Magellan Medicaid Administration (A) Corporate Policy: Policy Number: Policy Name: Date of Inception: January 1, 2007
More informationPolicies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005
POLICY/PROCEDURE NO.: B-17 Effective date: Jan. 1, 2007 Date(s) of review/revision: Nov. 1, 2015 Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005
More informationFraud, Waste and Abuse Prevention and Education Policy
Corporate Compliance Fraud, Waste and Abuse Prevention and Education Policy The Compliance Program at the Cortland Regional Medical Center (CRMC) demonstrates our commitment to uphold all federal and state
More informationFEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS. 1) Federal False Claims Act (31 USC 3729-3733)
FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS 1) Federal False Claims Act (31 USC 3729-3733) II. NEW YORK STATE LAWS A. CIVIL AND ADMINISTRATIVE LAWS 1) New York False Claims
More informationSummary: The Organization directs its activities in full compliance with Federal, State and Local laws and regulations.
Sunrise Community, Inc. and Affiliates, the Organization, shall comply with Section 6032 of the Deficit Reduction Act of 2005. The Whistleblower Protection Policy is designed to encourage and enable directors,
More informationTo: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center
To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center From: Corporate Compliance Department Re: Deficit Reduction Act of 2005 Dear Vendor/Agent/Contractor: Under the Deficit Reduction
More informationLast Approval Date: May 2008. Page 1 of 12 I. PURPOSE
Page 1 of 12 I. PURPOSE The purpose of this policy is to comply with the requirements in Section 6032 of the Deficit Reduction Act of 2005 (the DRA ), which amends Section 1902(a) of the Social Security
More informationMETHODIST HEALTH SYSTEM ADMINISTRATIVE TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS
METHODIST HEALTH SYSTEM ADMINISTRATIVE Formulated: 6/19/07 Reviewed: Revised: Effective: 10/30/07 TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS PURPOSE: Methodist
More informationCHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES
1. PURPOSE CHAMPAIGN COUNTY NURSING HOME SUMMARY OF ANTI-FRAUD AND ABUSE POLICIES Champaign County Nursing Home ( CCNH ) has established anti-fraud and abuse policies to prevent fraud, waste, and abuse
More informationC O N F I D E N T I A L A N D P R O P R I E T A R Y. Page 1 of 7 Title: FRAUD, WASTE, AND ABUSE POLICY
Page 1 of 7 1. Purpose As a Company that does business with U.S. state and federal government health care programs (such as Medicare and Medicaid), Hill-Rom is required to maintain a system of policies
More informationMetropolitan Jewish Health System and its Participating Agencies and Programs [MJHS]
Metropolitan Jewish Health System and its Participating Agencies and Programs [MJHS] POLICY PURSUANT TO THE FEDERAL DEFICIT REDUCTION ACT OF 2005: Detection and Prevention of Fraud, Waste, and Abuse and
More informationCOMMENTARY JONES DAY. FERA also purports to expand liability for the retention of money owed to the government. Under the old law,
June 2009 JONES DAY COMMENTARY Fraud Enforcement Recovery Act of 2009 Becomes Law, Expanding Exposure Under the False Claims Act and Funding Anti-Fraud Enforcement The Fraud Enforcement and Recovery Act
More informationCompliance with Applicable Federal and State Laws - False Claims Act and Similar Laws
Laws - False Claims Act and Similar Laws Purpose The purpose of this policy ( Policy ) is to provide information regarding: the federal and state False Claims Acts ( FCA ), related administrative remedies
More informationHospital Assocation of Southern California
Hospital Assocation of Southern California Recent Developments in Fraud Enforcement and Litigation; Practical Strategies to Minimize Risks and Liabilities David V. Marshall davidmarshall@dwt.com U.S. Department
More informationNorth Shore LIJ Health System, Inc.
North Shore LIJ Health System, Inc. POLICY TITLE: Detecting and Preventing Fraud, Waste, Abuse and Misconduct POLICY #: 800.09 System Approval Date: 6/23/14 Site Implementation Date: Prepared by: Office
More informationFraud/Abuse and False Claims Act Compliance Education for Providers, Contractors, and Vendors. Presented by: by: Compliance Department
Fraud/Abuse and False Claims Act Compliance Education for Providers, Contractors, and Vendors Presented by: by: Compliance Department 6/26/2013 Purpose Welcome to JHHC Corporate Compliance Training Program
More informationCompliance Lessons from Recent OIG Enforcement Activities. The Players. The Players Continued
Compliance Lessons from Recent OIG Enforcement Activities Sarah Duniway, Gray Plant Mooty Sara DeSanto, University of Minnesota Physicians July 14, 2015 The Players Office of Inspector General (OIG) Part
More informationStark Law Overpayments and False Claims Act Implications
Stark Law Overpayments and False Claims Act Implications American Health Lawyers Association, Institute for Medicare & Medicaid Payment Issues March 25 and 26, 2010 Michael W. Paddock, Esq. Crowell & Moring
More informationSCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005
Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Approver Approval Stage Date Chris Zorn Approval Event (Authoring) 12/09/2013 Nancy Monk Approval Event
More informationOIG Open Letter Regarding the Self-Disclosure Protocol: Further Refinements
2009 American Health Lawyers Association April 17, 2009 Vol. VII Issue 15 OIG Open Letter Regarding the Self-Disclosure Protocol: Further Refinements By Ritu Kaur Singh, Frank E. Sheeder III, and Gerald
More informationTENNCARE POLICY MANUAL
TENNCARE POLICY MANUAL Policy No: Pl 08-001 (Rev. 4) Subject: False Claims Act Policy Approval: Date: PURPOSE OF POLICY STATEMENT: The Bureau of TennCare is committed to its role in preventing health care
More informationCOUNTY OF ORANGE. False Claims Act and Whistleblower Provisions Policy and Procedures
COUNTY OF ORANGE False Claims Act and Whistleblower Provisions Policy and Procedures COUNTY OF ORANGE FALSE CLAIMS ACT AND WHISTLEBLOWER PROVISIONS POLICY AND PROCEDURES I. Purpose. The County of Orange
More informationSULLIVAN COUNTY EMPLOYEE ORIENTATION FACT SHEET # 31
SULLIVAN COUNTY EMPLOYEE ORIENTATION FACT SHEET # 31 SULLIVAN COUNTY CORPORATE COMPLIANCE SUBJECT: FALSE CLAIMS ACT STATEMENT OF POLICY: Sullivan County is committed to providing quality health care in
More informationAvoiding Medicaid Fraud. Odyssey House of Utah Questions? Contact your Program Director or Emily Capito, Director of Operations
Avoiding Medicaid Fraud Odyssey House of Utah Questions? Contact your Program Director or Emily Capito, Director of Operations MEDICAID FRAUD OVERVIEW Medicaid Fraud The Medicaid Program provides medical
More informationFALSE CLAIMS ACT PRACTICE PUBLICATIONS AND SPEECHES
FALSE CLAIMS ACT PRACTICE PUBLICATIONS AND SPEECHES FALSE CLAIMS ACT PUBLICATIONS Books Peter Hutt, Contractor and Subcontractor Liability Under the False Claims Act and Introduction to Damages and Penalties,
More informationMINNESOTA FALSE CLAIMS ACT. Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them.
As amended by Chapter 16 of the 2013 Minnesota Session Laws. 15C.01 DEFINITIONS MINNESOTA FALSE CLAIMS ACT Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings
More informationCORPORATE COMPLIANCE: BILLING & CODING COMPLIANCE
SUBJECT: CORPORATE COMPLIANCE: BILLING & CODING COMPLIANCE MISSION: Quality, honesty and integrity, in everything we do, are important values to all of us who are associated with ENTITY NAME ( ENTITY NAME
More informationReports of Compliance Concerns and Violations
The University of Chicago Medical Center Compliance Manual (UCHHS;BSD;UCPP) Reports of Compliance Concerns and Violations Issued: November 1, 1999 Reports of Compliance Concerns and Violations Revised:
More informationFEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS
FEDERAL & NEW YORK STATUTES RELATING TO FILING FALSE CLAIMS I. FEDERAL LAWS False Claims Act (31 USC 3729-3733) The False Claims Act ("FCA") provides, in pertinent part, that: (a) Any person who (1) knowingly
More informationMEMORANDUM. Wayne A. McNulty Senior Assistant Vice President & Chief Corporate Compliance Officer. DATE: September 29, 2015 DEFICIT REDUCTION ACT
nyc.gov/hhc O F F I C E O F C O R P O R A T E C O M P L I A N C E * 160 Water Street, Suite 1129, New York, NY 10038 * Tel: (646) 458-7799 * e-mail: wayne.mcnulty@nychhc.org Wayne A. McNulty, Esq., CHC,
More informationFalse Claims Act and Qui Tam Lawsuits: Whistleblower Claims
False Claims Act and Qui Tam Lawsuits: Whistleblower Claims FRAUD IS YOUR COMPANY TOO BIG TOO FALL? ENRON? enron the smartest guys in the room - Trailer.webm 2 False Claims Act Basics To state a claim,
More informationCPCA California Primary Care Association
CPCA California Primary Care Association Managing the Compliance Risk of Fraud, Abuse and the False Claims Act CPCA CFO Conference Larry Garcia Kenneth Julian April 30, 2010 Background The Patient Protection
More informationPOLICY AND PROCEDURES MANUAL FRAUD, WASTE, AND ABUSE
Page Number: 1 of 7 TITLE: PURPOSE: FRAUD, WASTE, AND ABUSE The Harris County Hospital District implemented a Corporate Compliance Program in an effort to establish effective internal controls that promote
More informationHERITAGE FARM POLICY AND PROCEDURES. Policy: False Claims Act and Whistleblower Provisions
HERITAGE FARM POLICY AND PROCEDURES Policy: False Claims Act and Whistleblower Provisions Date: October 8, 2013 Rationale: It is Heritage Farm s intent to make sure all claims are submitted in a timely
More informationColorado West HealthCare System Grand Junction, CO
Policy Title: Effective Date: 1/30/2008 Supersedes Date: N/A Colorado West HealthCare System Grand Junction, CO CWHS-WIDE POLICY FALSE CLAIMS ACT Responsible Departments: All Departments Administration
More informationHow To Get A Medical Bill Of Health From A Member Of A Health Care Provider
Neighborhood requires compliance with all laws applicable to the organization s business, including insistence on compliance with all applicable federal and state laws dealing with false claims and false
More informationCompliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures
CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY and TOOMEY RESIDENTIAL AND COMMUNITY SERVICES Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures Purpose:
More informationAHLA. The False Claims Act: A Powerful Enforcement Tool. Michael E. Paulhus King & Spalding LLP Atlanta, GA
AHLA The False Claims Act: A Powerful Enforcement Tool Michael E. Paulhus King & Spalding LLP Atlanta, GA Fundamentals of Health Law November 12-14, 2014 The False Claims Act: A Powerful Enforcement Tool
More informationFalse Claims / Federal Deficit Reduction Act Notice Help Stop Healthcare Fraud, Waste and Abuse: Report to the Firelands Corporate Compliance Officer
1111 Hayes Avenue Sandusky, OH 44870 www.firelands.com False Claims / Federal Deficit Reduction Act Notice Help Stop Healthcare Fraud, Waste and Abuse: Report to the Firelands Corporate Compliance Officer
More informationFederal False Claims Act
Page 1 of 5 False Claims Recovery Policy HMSA must provide information about the following subjects to all HMSA employees and HMSA contractors and agents, who, on behalf of The HMSA Plan for QUEST Members,
More informationADMINISTRATIVE POLICY SECTION: CORPORATE COMPLIANCE Revised Date: 2/26/15 TITLE: FALSE CLAIMS ACT & WHISTLEBLOWER PROVISIONS
Corporate Compliance Plan AD-819-0 Reporting of Compliance Concerns & Non-retaliation AD-807-0 Compliance Training Policy CFC ADMINISTRATIVE POLICY AD-819-1 SECTION: CORPORATE COMPLIANCE Revised Date:
More informationNewYork-Presbyterian Hospital Sites: All Centers Hospital Policy and Procedure Manual Number: D160 Page 1 of 9
Page 1 of 9 TITLE: FEDERAL DEFICIT REDUCTION ACT OF 2005 FRAUD AND ABUSE PROVISIONS POLICY: NewYork- Presbyterian Hospital (NYP or the Hospital) is committed to preventing and detecting any fraud, waste,
More informationDeficit Reduction Act Information for Employees, Contractors and Agents
Nationally Ranked. Locally Trusted. Denver Health Deficit Reduction Act Information for Employees, Contractors and Agents EFFECTIVE DATE: DECEMBER 31, 2006 PAGE 1 OF 5 Purpose: Provide a written policy
More informationPolicy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act
Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act SCOPE OF POLICY This policy applies to all CFS employees, including trainees, volunteers,
More informationFederal False Claims Act (31 USC 3729 through 3733)
I. INTRODUCTION The False Claims Act (FCA) is a federal law that was created to discourage and punish profiteers from providing sub-standard supplies to the Union Army during the Civil War. The FCA was
More information2012-2013 MEDICARE COMPLIANCE TRAINING EMPLOYEES & FDR S. 2012 Revised
2012-2013 MEDICARE COMPLIANCE TRAINING EMPLOYEES & FDR S 2012 Revised 1 Introduction CMS Requirements As of January 1, 2011, Federal Regulations require that Medicare Advantage Organizations (MAOs) and
More informationDeficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery
DMH S&P No. 1 Revision No. N/A Effective Date: 01/01/07 COMPLIANCE STANDARD: Deficit Reduction Act of 2005 6032 Employee Education About False Claims Recovery BACKGROUND AND PURPOSE As stated in its Directive
More informationSELF AUDITS AND DISCLOSURES IN A RAC WORLD. Kathleen Houston Drummy Partner Davis Wright Tremaine LLP Los Angeles, CA
SELF AUDITS AND DISCLOSURES IN A RAC WORLD Kathleen Houston Drummy Partner Davis Wright Tremaine LLP Los Angeles, CA 1 Broader Program Integrity Landscape Improper Payments As a result of error As a result
More informationCorporate Compliance Policy Concerning the False Claims Acts, Anti- Retaliation Protections, and Detecting and Responding to Fraud
PAGE NUMBER: 1 of 16 ACCOUNTABILITY: President and Chief Executive Officer OBJECTIVES: RELATION TO MISSION: Our Lady of Lourdes Health Care Services, Inc. ( OLLHCS, Inc. ), a Catholic health system and
More informationLori Pines Steven A. Reiss Konrad Cailteux with guest speaker Gregory M. Krakower, Senior Advisor and Counselor to the New York Attorney General
Lori Pines Steven A. Reiss Konrad Cailteux with guest speaker Gregory M. Krakower, Senior Advisor and Counselor to the New York Attorney General November 13, 2013 Footer / document number goes here Panelists
More informationMinnesota False Claims Act
Minnesota False Claims Act (Minn. Stat. 15C.01 to.16) i 15C.01 DEFINITIONS Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim.
More informationFraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005. Presented by: MARCH Vision Care, 2013
Fraud, Waste & Abuse DEFICIT REDUCTION ACT OF 2005 Presented by: MARCH Vision Care, 2013 DISCLAIMER This training was created as a guide by MARCH and shall not be construed to contain all contractual requirements
More informationRepresenting Whistleblowers Nationwide
Minnesota False Claims Act Minnesota Stat. 15C.01 to 15C.16) 15C.01 DEFINITIONS Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them. Subd. 2. Claim.
More informationPOLICY ON THE FALSE CLAIMS ACTS
EAST ORANGE GENERAL HOSPITAL COMPLIANCE POLICY Title: Policy on The False Claims Acts Code No.: Section: Corporate Compliance Effective Date: March 1, 2015 Approved by: Compliance Officer Publication Status:
More informationESTABLISHING POLICY AND PROCEDURES FOR COMPLIACE WITH 42 USC 139a(a)(68), False Claims and Whistle Blower Protections
RESOLUTION NO. COA-falseclaimsandwhistlesrev. 93-10 Date: 2/23/2010 ESTABLISHING POLICY AND PROCEDURES FOR COMPLIACE WITH 42 USC 139a(a)(68), False Claims and Whistle Blower Protections BY: Mr. George
More informationNew False Claims Act Exposures and Government Investigation Tips. Robert T. Rhoad Christopher K. Lui
New False Claims Act Exposures and Government Investigation Tips for Health Plans Robert T. Rhoad Christopher K. Lui Roadmap False Claims Act ( FCA ) Basics Recent Amendments to the FCA Heightened Enforcement
More informationPolicies and Procedures SECTION:
PAGE 1 OF 5 I. PURPOSE The purpose of this Policy is to fulfill the requirements of Section 6032 of the Deficit Reduction Act of 2005 by providing to Creighton University employees and employees of contractors
More informationNC General Statutes - Chapter 1 Article 51 1
Article 51. False Claims Act. 1-605. Short title; purpose. (a) This Article shall be known and may be cited as the False Claims Act. (b) The purpose of this Article is to deter persons from knowingly causing
More informationHACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual
HACKENSACK UNIVERSITY MEDICAL CENTER Administrative Policy Manual Fraud and Abuse Prevention DRA Compliance Policy #: 1521 Original Issue: December, 2007 Page 1 of 6 Policy It is the policy of Hackensack
More informationNEW YORK FALSE CLAIMS ACT
NEW YORK FALSE CLAIMS ACT STATE FINANCE LAW, ART. XIII (2013) 187. SHORT TITLE This article shall be known and may be cited as the "New York false claims act". 188. DEFINITIONS As used in this article,
More informationAccountability Report Card Summary 2013 New Mexico
Accountability Report Card Summary 2013 New Mexico New Mexico has a pretty strong state whistleblower law: Scoring 72 out of a possible 100 points; Ranking 4 th out of 51 (50 states and the District of
More information1 2 3 4 Currently, the government is extremely focused on cracking down on health care fraud. The government created the Health Care Fraud Prevention and Enforcement Action Team ( HEAT ) in May 2009 as
More informationAddressing Government Investigations. Marcos Daniel Jimenez Partner
Addressing Government Investigations Marcos Daniel Jimenez Partner November 14, 2014 Agenda Statistics Key Players Fraud and Abuse Laws Potential Consequences Mitigation Strategies 2 Key Health Care Fraud
More informationHandling Disagreement with Superiors Decisions and Whistleblowing
Handling Disagreement with Superiors Decisions and Whistleblowing The mandate of the Office of Inspector General (OIG) is to root out fraud, waste, and abuse, as well as promote the economy and efficiency
More informationFEDERAL AND STATE FALSE CLAIMS ACT, ADMINISTRATIVE PENALTIES AND WHISTLEBLOWER PROTECTION LAWS:
Corporate Compliance Fraud, Waste, Abuse and Whistleblower Education The Compliance Program at Cortland Regional Medical Center (CRMC) demonstrates our commitment to uphold all federal and state laws and
More informationSecondary Department(s): Corporate Investigations Date Policy Last Reviewed: September 28, 2012. Approval/Signature:
Subject: OBE-9 Fraud, Waste, and Abuse Detection and Prevention in Health Plan Operations Primary Department: Office of Business Ethics Effective Date of Policy: September 26, 2008 Plan CEO Approval/Signature:
More informationADMINISTRATIVE POLICY MANUAL
SUPERSEDES: New PAGE: 838.00 POLICY: 1. It is the policy of Onondaga County hereinafter referred to as the County, to comply with all applicable federal, state and local laws and regulations, both civil
More informationCAPITAL REGION MEDICAL CENTER ADMINISTRATIVE POLICY MANUAL
CAPITAL REGION MEDICAL CENTER ADMINISTRATIVE POLICY MANUAL ARTICLE: 5 SECTION: B SUBJECT: Leadership NUMBER: 79 DATE: January 1, 2007 SUPERSEDES Policy No. Dated: REVIEWED: March 24, 2010 PURPOSE The purpose
More informationCoffee Regional Medical Center FALSE CLAIMS EDUCATION
Policy/Procedure Department Administration Effective 08/15/2008 Scope Organization Cross Reference Review Date 08/14/2008,12/18/2013 Revision History Signatures Date 12/18/2013 Prepared by Lavonda Cravey
More informationTHE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES FALSE CLAIMS AND WHISTLEBLOWER PROTECTIONS
THE COUNTY OF MONTGOMERY POLICIES AND PROCEDURES POLICY It is the obligation of the County of Montgomery (the County ) to prevent and detect any fraud, waste and abuse in its organization related to Federal
More informationThe False Claims Act and the Financial Sector: New Risks, New Compliance Strategies. Jennifer O Connor Jody Kris Jonathan Cedarbaum May 28, 2009
The False Claims Act and the Financial Sector: New Risks, New Compliance Strategies Jennifer O Connor Jody Kris Jonathan Cedarbaum May 28, 2009 Introduction The False Claims Act Now Matters More than Ever
More informationDCAA Audits of Compliance Systems and the Implications of Changes in the False Claims Act for Universities
DCAA Audits of Compliance Systems and the Implications of Changes in the False Claims Act for Universities SCCE s Higher Education Compliance Conference Kwamina Thomas Williford Partner, Holland & Knight
More informationCORPORATE COMPLIANCE POLICY AND PROCEDURE
Title: Fraud Waste and Abuse Laws in Health Care Policy # 1011 Sponsor: Corporate Compliance Approved by: Carleen Dunne, Director, Corporate Compliance and Privacy Officer Issued: Page: 1 of 7 June 25,
More information