Publications: Ask the Legal Expert - September 2007

This issue we continue a discussion of corporate compliance programs, including how suspected fraud or abuse should be reported.

Enforcing federal agencies encourage healthcare organizations to develop compliance programs - indeed some organizations are required to have a program. The Deficit Reduction Act of 2005 ("DRA") mandates entities that receive at least $5 million annually in Medicaid funds to educate their employees and others about the Federal False Claims Act ("FCA") and its whistleblower protections.

Among other provisions. the FCA permits the bringing of qui tam actions by whistleblowers, also known as "relators,"' who suspect that false claims have been submitted for payment to government. A whistleblower initiates a private lawsuit against a healthcare provider on behalf of the government, and the Department of Justice may later intervene in the suit. Whistleblowers bringing successful qui tam actions may receive between 15% and 30% of any recovery, in addition to payment for reasonable expenses.

The FCA prohibits an employer's retaliation against an employee who makes a good faith complaint about a potential false claim. The DRA requires employees to be educated about protections available under federal and state law to individuals reporting these issues.

Well-publicized, anonymous hotlines should be available to accept complaints.

Reproduced with permission from McKnight's Long-Term Care News.

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