False Claims Act Essay

Whistleblowers and the False Claims Act

Whistleblowers are expected to give close attention to the act’s specific provisions. A number of state false claims acts have been enacted as a result of financial incentives that sparked activity in American legislatures. The federal government has established the Federal False Claims Act as an effective and efficient weapon in combating fraud. This law, which is frequently referred to as the Lincoln’s Law, was not well implemented after its initial years of passage. As a result of the cases filed under the Act, the federal government was in a position to recover $48 billion between 1986-2015, most of which came from the healthcare sector (Krause, 2016). More recently, whistleblowers have been an integral part of the act’s success under the provisions of qui tam. In return, the whistleblowers get statutory rewards for acting on behalf of the federal government in filing cases. The federal government often has limited information as well as resources to deal with those submitting fraudulent and false claims. However, with the incorporation of the citizens’ whistleblowers, fraudulent activities that would have gone undetected have been brought to light.

Lawsuits and Liability Provisions

Under the False Claims Act, a lawsuit can shake or threaten the survival of the medical practice. Any violations cause a liability for the damages and at times, civil penalties. Medical practitioners are thus sensitized to be aware of all the provisions of the act. The act has been proven as a successful tool in fighting fraud in Medicaid, Medicare as well as other health care programs funded by the federal government. Under 31 U.S.C §§ 3729-33 provision of the act, the government has the right to recover penalties as well as treble damages against the people who violate its provisions. Whistleblowers can be considered as being turned into bounty hunters who can be patients, employees, competitors or providers of health care services. Liability Provisions under the Act clearly stipulates the conditions under which one can be considered as having violated the law. The presentation of false and fraudulent claims or conspiring in the committing violations invites punishments. These are stated under the subparagraphs (A) to (G) with the likelihood of paying civil penalties of up to $11,000 for every violation.

Impact on Medical Practices

An analysis of the United States v. Neifert-White Company (1968) shows that the Supreme Court made a significant ruling in relation to the False Claims Act which impacted on medical practices (Munich & Lane, 1999). The Act comes in where the practices bill government programs for those services which are not rendered. Upcoding also calls for the referencing the Act and entails the provision of services to patients with billings directed to the insurance programs that are funded by the government. Such services may end up being substandard for both the patient and the government payor. Therefore, whenever services are intentionally withheld, the healthcare providers are held liable under the Act. The Act also comes in when the providers give quality services, but the claims are regarded as “false” as a result of the services violating other laws which can result in the denial of payment by the payor when the violations are discovered. Whenever medical practices violate the anti-kickback statute, even if the services are medically appropriate, claims made are violations of The False Claims Act.

Legal Breaches and Liability

Ethical and legal breaches are evident in carrying out the law. A good example is that of United States “Cafasso v. Gen. Dynamics C4 Sys where a whistleblower was found to have breached the confidentiality agreement after copying 11GBs of data in a computer firm (Cobb & McKenzie, 2016). The district court arrived at the conclusion that the public policy could not immunize Cafasso and therefore ruled in the defendant’s favor. Cafasso had confused the protection of the whistleblowers with the lawful reporting of fraud. There are different circumstances which call for liability under FCA which also trigger a liability in the traditional breach of contract through various cases. The traditional contract law held it that one is liable for a breach when there is a direct form of contractual relationship with the breach’s victim. Contrary to this, the Act an individual is liable even if the dealings were not direct to the government. In the provisions under the § 3730(b)(2) one has the right to present claims through demanding for payments to another entity or a person that the government gives some funds that are demanded (Meador & Warren, 1997).

Ensuring Compliance and Consequences

All the involved parties under the act should always ensure that they comply with the provisions which should be followed to the letter. At the minimum requirements, there must be the appointment of compliance officers who give relevant information to the employees about possibilities of fraud. Besides employees as well as patients should be encouraged to be filing complaints where there are improper actions being undertaken. There should also be a program that gives room for anonymous complaints to be aware of the investigation’s detailed process. The department of health can also reap maximum benefits through conducting frequent audits through the sampling of claims that are supposed to be factored in the compliance program.

Conclusion

Summarily, the range of conduct under the provisions of the False Claims Act are very broad. The penalties, as well as the damages incurred as a result of the violations, are very severe. Competitors, employees amongst others get strong financial incentives in filing the qui tam suits that are stipulated under the act. Ethical issues arise as the Act is put into practice although the various laws in the country help in solving such dilemmas. The structure of the Act deputizes the private citizens who act well in the representation of the public interests for what can be considered as private gains. This is the major cause of the ethical as well as legal issues under the qui tam. Qui Tam’s early stages of litigation are full of ethical issues for both the defendants and the relators who should be more aware of the professional and ethical obligations. The False Claims Act will remain to be a statute under which every person who is involved in the medical practice should be aware of all the provisions to avoid being on the wrong side of the law. In as far as the provision of quality services is concerned, it can be said that the private and the public sector are making significant achievement and progress through effective laws such as the FCA. There is a need to ensure that the law is always dynamic to match the needs of the ever-growing demands in the delivery of public service.

References

Cobb, J., & McKenzie-Harris, M. L. (2016). Ethical Implications of Document Use in Whistleblower and Retaliation Litigation. ABA Journal of Labor & Employment Law, 31(3), 471.

Krause, J. H. (2016). Truth, Falsity, and Fraud: Off-Label Drug Settlements and the Future of the Civil False Claims Act.

Meador, P., & Warren, E. S. (1997). The False Claims Act: A Civil War Relic Evolves into a Modern Weapon. Tenn. L. Rev., 65, 455.

Munich, J. R., & Lane, E. W. (1999). When Neglect Becomes Fraud: Quality of Care and False Claims. . Louis ULJ, 43, 27.