The inpatient protection and Affordable Care Act of 2010 (Ppaca) dramatically expands the scope of exposure for health care providers under the False Claims Act (Fca), intensifying providers' need for heightened compliance.
The Ppaca makes reporting and repaying any overpayment an "obligation" under the Fca, creating a direct link in the middle of the failure to promptly refund overpayments and possible liability under the Fca. New deadlines imposed by the laws expressly need providers, suppliers and health plans to "report and refund" any "overpayment" by the later of "60 days after the date on which the overpayment was identified" or "the date any corresponding cost narrative is due."
Health Care Reforms
Fca violations may consequent in requisite monetary penalties of ,500 - ,000 per claim, plus treble damages. In addition, Section 6502 of the Ppaca makes "unpaid overpayments" also grounds for Medicaid program exclusion.
There are a broad range of areas in which overpayments trigger reporting and refund obligations under teh Ppaca, together with determinations that services were not medically necessary, duplicate payments and Stark law violations arising from referral arrangements in the middle of providers.
Prudent health care providers and suppliers should take immediate steps to minimize possible liability under these new laws. Providers and suppliers are urged to quote their existing yielding programs, which are made mandatory under the Ppaca, and to make sure that their staff is strictly adhering to these policies and procedures. Further, it is probably in their best interest to make new policies that streamline the reporting and refunding of suspected overpayments once they have been identified. Finally, these new laws guarantee a truthful quote of all contracts and contractual relations in the middle of providers and referring physicians to ensure full Stark law compliance.
New health Care Reforms growth Providers' Exposure Under False Claims Act
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