Medicare Compliance & Reimbursement

Provider group challenges what it sees as an inappropriate use of the law. The American Hospital Association recently addressed what some in the industry see as a troubling trend: the government's use of the False Claims Act as a hammer for collecting settlements from providers. In a September letter to U.S. Attorney General Eric Holder Jr. and HHS Secretary Kathleen Sebelius, the trade group asks the cabinet-level Health Care Fraud Prevention and Enforcement Action Team to do a policy review of FCA initiatives currently underway. The False Claims Act doesn't apply to "billing errors, mistakes or even nonculpable overutilization," as the Department of Justice explained to Congress related to amendments expanding the FCA's authority to pursue violations, AHA points out in its correspondence. Yet the government is initiating "aggressive FCA investigations" when it uncovers evidence of a mistake or overutilization. This makes "FCA enforcement through negotiated 'settlement' a self-fulfilling prophecy," [...]