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Home health agency exec on hook for millions in FCA violations

A myriad of federal and local regulations is in place to guide the practices of those who run businesses or organizations that provide skilled nursing services and other forms of medical care to patients. A failure to follow these laws can result in allegations of wrongdoing. These allegations can lead to civil or even criminal liability. As a result, it is important for those who work in this field to be aware of these laws. The Federal Claims Act is one such regulation.

What is the Federal Claims Act?

The Federal Claims Act (FCA) is a federal law that makes it illegal to file a false claim for payment with the government. As a result, the FCA holds those accountable who file fraudulent claims for payment under Medicare and Medicaid. It is important to note that the law provides incentive for workers within an organization to file a claim on behalf of the government if they notice a potential violation of this law. If successful, the worker who brought the whistleblower or qui tam claim can receive a percentage of any award given to the government.

How do FCA cases unfold?

In a recent example, the United States Department of Justice (DOJ) is working to hold two former home health agency executives accountable for an FCA violation tied to allegations the entrepreneurs bribed other medical professionals to refer patients to their facilities and billed for services that were not medically necessary.

When faced with these allegations, the two execs chose to negotiate a settlement. As part of the agreement, the two will pay the government over $5 million to settle the claim.