Blog

July 1, 2014

Overpayments the Subject of a New False Claims Act Action


In 2009, Congress amended the Federal False Claims Act ("FCA") to include a "reverse false claims" provision that covers any knowing retention and failure to refund payments that were received from the Federal government in error.   One year later, Section 6402(d) of the Affordable Care Act advanced this FCA provision by establishing a 60-day timeline within which health care providers and suppliers are required to identify, report and return overpayments to the Medicare and Medicaid programs.  On February 16, 2012, the Department of Health and Human Services ("HHS") published a proposed rule on overpayments which has yet to be finalized.  Please click here for more information.

In reliance on these requirements, the U.S. Department of Justice ("DOJ") intervened in a FCA action last week - U.S. v. Continuum Health Partners, Inc. et al - which gives the subject of overpayments greater significance for all health care providers and suppliers.  Please click here for more information. 

According to the allegations set out in the complaint, New York's Mount Sinai Health System knowingly retained and failed to refund payments for more than 900 Medicaid claims that were billed incorrectly due to a computer program malfunction.  The DOJ is seeking the maximum civil money penalties under the FCA -- specifically $11,000 per overpayment or $9.9 million in total -- plus treble damages. 

Krieg DeVault continues to work closely with health care providers and suppliers in implementing the compliance program infrastructure necessary to properly identify, report and return overpayments to the Medicare and Medicaid programs. 

Please contact Susan Ziel at sziel@kdlegal.com if you have any questions or if we can advise your organization regarding these increasingly important compliance matters.