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“Before The OIG Comes Knocking”

December 7, 2010 | No Comments
Posted by Sharlene Hunt

Changes made to the federal laws over the past year and a half have greatly increased the exposure of medical practices under the federal False Claims Act. As part of these changes, it is now a violation of the False Claims Act to retain an overpayment received from the Medicare or Medicaid program, and physicians and other health care providers now have an affirmative obligation to report and refund any overpayments of which they become aware. A violation of the antikickback law or the physician self-referral law (the “Stark” law) is also a violation of the False Claims Act. Before your practice gets a visit from the Office of the Inspector General, you should put in place policies and practices to avoid overpayments and to identify them and take appropriate steps if an overpayment is received.

The False Claims Act authorizes the imposition of civil monetary penalties (including treble damages) for a violation of the statute. The government may also seek exclusion  from participation for a practice that violates the statute or for obstructing an investigation, Being excluded from Medicare would not only bar the practice from providing services to Medicare and Medicaid beneficiaries, but could also have a negative impact on  Medical Staff privileges and the ability to participate with private insurance companies and managed care companies.

To read the full article, click here.


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