The False Claims Act is a federal law that allows the government or private individuals to file a claim against those who allegedly make false claims for payment against the United States. It is common for an individual to file suit and the government to join in at a later date. These cases can include physicians and health care providers that charge Medicare or Medicaid for services provided to patients.
In this case, a patient filed suit against a provider alleging a False Claims Act and Anti-Kickback Statute violation.
Why would a patient file this type of suit? If successful the patient can receive a portion of any monetary awards that result from the allegations.
What were the allegations in this case? In this case, the patient accused the provider of illegally enticing patients with monetary kickbacks. More specifically, the patient states the accused offered a $25 Walmart gift card in exchange for enrolling in a house call program.
In its analysis, the court states the purpose of the Anti-Kickback Statute is “to prevent kickbacks from influencing the provision of services that are charged to Medicare.” In this case, the court found the patient failed to establish the gift card led to services charged to Medicare. As a result, the case was thrown out.
What can healthcare providers learn from this case? Allegations of Anti-Kickback Statute violations require particularity to move forward in court. A weak case will not likely survive. However, if a case does survive and move forward it is likely the patient or filing party has sufficient evidence to support their claim. As such, those accused of the violation are wise to build a defense to the allegations. An attorney experienced in Anti-Kickback Statute violations can help.