Summary
The False Claims Act (FCA) was first enacted in 1863 as a result of defense contractor fraud at the time of the Civil War. According to the FCA, any individual who knowingly makes a false record or claims in regard to any healthcare system or program is considered a criminal (The United States Department of Justice [USDJ], 2022). Since its initial enactment, the FCA has undergone several amendments, and at present, those who violate it are liable for “treble damages plus a penalty that is linked to inflation” (USDJ, 2022, para. 2). The additional penalty amount varies from $5,500.00 to $11,000.00 per claim (“False Claims Act,” n.d.). As of the fiscal year 2021, the US Department of Justice received over $5.6 billion in settlements and judgments under the FCA.
To encourage individuals to report cases of false claims, the government protects whistleblowers from “discrimination, harassment, suspension or termination of employment” (“False Claims Act,” n.d., para. 4). Employees who suffer as a result of reporting fraud may receive one of several types of awards or compensation. These include the compensation of any damages or costs they incurred, the reinstatement of their position in the organization, or double back pay plus interest. Apart from the government being allowed to pursue perpetrators, the FCA also enables private citizens to file the so-called ‘qui tam’ suits on behalf of the government.
Apart from the FCA, several other fraud and abuse laws are applied to healthcare workers. These laws are the Physician Self-Referral Law (Stark law), the Anti-Kickback Statute (AKS), the Civil Monetary Penalties Law (CMPL), and the Exclusion Statute (U. S. Department of Health and Human Services [USDHHS], n.d.). The Stark law prohibits referring patients to receiving Medicare- and Medicaid-payable services. The AKS is a criminal law under which it is prohibited to receive payment for patient referrals. Penalties under the AKS include imprisonment, fines, and exclusion from participation in federal health programs (USDHHS, n.d.). The CMPL covers a number of issues, such as the violation of Medicare assignment provisions, Medicare agreements, or the AKS (USDHHS, n.d.). Finally, the Exclusion Statute presupposes excluding from all federal health programs the individuals involved in the illegal manufacture, prescription, or distribution of controlled substances, financial misconduct, and others.
The level of government responsible for overseeing the FCA is the federal government, namely, the Department of Justice. The regulation has greatly impacted the healthcare sector since it allows eliminating the instances of billing for the same service more than once or for the service not provided, as well as making false statements with the aim of receiving payment for services (“False Claims Act,” n.d.). Moreover, with the help of money collected via fines and penalties, the healthcare sector is supported financially.
Peer Response
The Emergency Medical Treatment and Labor Act (EMTALA) helps to meet the gap in health care by providing opportunities for underserved populations to receive equal access to treatment. Unfortunately, due to some patients’ poverty, some emergency departments did not use to accept patients, transporting them to surrounding areas. With the help of the EMTALA, however, patients are able to receive emergency treatment irrespective of their ability to pay for the services. This is especially valuable for patients in labor who frequently cannot afford to travel to a different healthcare facility. The requirements of EMTALA support the FCA in that a physician may falsely identify a case as an emergency when it is possible to transport the patient to another facility without any risk to their health. In that case, the FCA can be enacted on such a healthcare professional.
References
False Claims Act. (n.d.). Total Health Care. Web.
The United States Department of Justice. (2022). The False Claims Act. Web.
U. S. Department of Health and Human Services. (n.d.). Fraud and abuse laws. Web.