SPEA-H 341 Chapter Notes - Chapter 15: False Claims Act, Qui Tam

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Bloomington hospital pays . 4 million in false medicare claims dispute. Who investigates fraud: fbi, department of justice, dhhs (cms, oig, pros) Individuals can also enforce these laws: private individuals who have firsthand knowledge of fraud are permitted to sue on behalf of the government and to collect a percentage of the proceeds recovered, if any. Medicare diagnosis-related group payment and shall not be billed separately. If you are brought in for a procedure, on an outpatient basis, for an inpatient surgery, the 3 days is a rule, everyday has to be billed together. Lincoln law: claiming you"ve paid or supplied more than you actually did. Government needs to prove: person has to have actual knowledge that the information is false, act with deliberate ignorance, act with reckless disregard. Healthcare avoiding false claims: must have a mechanism in place that checks all the steps of the false claim to avoid the.

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