Total Health Care is committed to reducing waste, fraud, and abuse in the healthcare industry through its Compliance program and other policies. Total Health Care, a federally funded health plan, is responsible for providing detailed information about Federal and State False Claims Acts as well as related False Claims Act protection laws, to all employees, contractors, associates, agents, and agents.
Overview
False Claims Act
False Claim Act, a federal law, makes it a crime to knowingly file false claims or make false records regarding federal health programs. This includes any program or plan that provides health benefits directly or through insurance. It is also funded in whole or in part by the United States Government. A claim can be known to be false if it is made with knowledge or reckless disregard.
The state has also adopted similar laws under the Michigan Medicaid False Claims Act. The MMFCA was created to stop fraud, kickbacks, and conspiracies related to the Medicaid program.
False claims can include billing for services that were not rendered, billing for the same services more than once, or false statements in order to get payment.
Penalties under the False Claims Act
Federal False Claims Act violations can lead to severe penalties and fines. The person or organization can be subject to financial penalties. These include a three-fold recovery of the false claim(s), and an additional penalty of $5500.00 to $11,000.00 for each claim.
Violations of the MMFCA are a felony that can lead to imprisonment or a $50,000 fine or both. Any person who, through fraud, receives a benefit; makes a false statement; or knowingly conceals material facts is subject to civil penalties equal to the amount received plus triple damages.
Whistleblower Protection under the False Claims Act
Employees who report fraud are protected by the federal False Claims Act. They can report any violation and be subject to discrimination, harassment or suspension of employment. Reporting fraud can result in discrimination. Employees may be eligible for (1) two-fold their back pay plus interest, (2) a reinstatement of their job without losing their seniority, and (3) compensation to cover any losses or damages.
Qui Tam Plaintiff/Relator
A qui tam plaintiff (or relator) is an individual who is an original source for information and can sue the government for violating the False Claims Act. A qui tam plaintiff may receive 15-25% of the amount recovered if the government charges and 25-30% if it is litigated by the qui-tam plaintiff.
