Healthcare fraud: False Claims Act will get boost from reform

Over the past several weeks, the U.S. Department of Justice (DOJ) has announced several fairly significant False Claims Act (FCA) settlements with healthcare providers, and such settlements could begin arriving at warp speed in the coming years now that the Patient Protection and Affordable Care Act has strengthened the FCA, according to the Taxpayers Against Fraud (TAF).

"Congress has stepped in to send a clear signal that it intends to wage a serious and protracted battle against fraud," says TAF President Jeb White. "We are especially pleased that Congressman Howard Berman (D-Calif.) and Senator Patrick Leahy (D-Vt.) recognized the need to clarify the public disclosure language of the False Claims Act in order to prevent fraud feasors from gutting meritorious cases. Congress has quite correctly decided that the U.S. Department of Justice should be the first decider when it comes to public disclosure decisions, rather than those engaged in lying, stealing and cheating U.S. taxpayers. In addition, the legislation underscores that health care providers engaged in kickbacks are also subject to the False Claims Act."

The new law provides only an extra $10 million a year to fight health fraud. However, the still-pending Health Care and Education Reconciliation Act of 2010 (H.R.4872), if passed by the Senate, could increase funding for health care law enforcement by $250 million over the next 10 years.

Recent FCA settlements include the following:

Florida healthcare provider Melbourne Internal Medicine Associates P.A. (MIMA) and an individual physician will pay $12 million for allegedly submitting false claims for certain radiation oncology services to Medicare and the military's health care program, TRICARE. MIMA was accused of billing for services not supervised, duplicate and unnecessary services, services not rendered and upcoded services.

New Jersey-based Robert Wood Johnson University Hospital - Hamilton will pay $6.35 million to settle allegations that the hospital defrauded Medicare by inflating its charges to Medicare patients to obtain larger reimbursements.

Rush University Medical Center in Chicago will pay more than $1.5 million to resolve FCA allegations that the facility submitted false claims to Medicare due to leasing arrangements with physicians that violated

To learn more about the impact of the Patient Protection Act:
- read the TAF press release

To learn more about the Florida settlement:
- read the DOJ press release

To learn more about the New Jersey settlement:
- read the DOJ press release

To learn more about the Illinois settlement:
- read the DOJ press release