False Claims Act Information

As recipients of federal health care program funds, including Medicare and Medicaid, 法律要求医疗保健组织为所有员工提供, 代理商和承包商关于联邦虚假申报法的信息, the federal Program Fraud Civil Remedies Act, 以及任何旨在防止和发现欺诈行为的适用州法律, waste and abuse in federal health care programs.

What is the False Claims Act (FCA)?

FCA是一项联邦法律,规定任何个人或组织故意做出虚假记录或向政府提出虚假索赔都是犯罪行为. “明知”包括实际知道某项主张是错误的, 或者以“故意无知”或“鲁莽无视”的方式行事,以判断一项主张是否属实. 可能的虚假索赔的例子包括为未提供的服务支付医疗保险费用, 为比实际提供的服务更高级别的服务计费(升级编码), or billing for services that were not ordered by a physician.

FCA包含允许个人拥有原始信息的条款.e., 涉及政府项目的欺诈信息(尚未成为法律诉讼对象的信息或已公开披露的活动),以代表政府提起诉讼, if the lawsuit is successful, to receive a portion of recoveries received by the government. New York updated its False Claims Act in 2013.

Penalties for Violating the False Claims Act

对提交虚假索赔的组织的经济处罚最多可达索赔金额的三倍,再加上高达50美元的罚款,000 per claim. In addition to fines and penalties, 违反《世界博彩公司十大排名》的个人或组织将被排除在联邦资助的医疗保健计划之外. New York’s False Claims Act provides for a penalty of between $11,803 and $23,每项索赔331美元,可追回的损害赔偿金额为虚假收到的金额的2至3倍.

Protections Under the False Claims Act

There is a qui tam《亚洲十大博彩公司排名》(False Claims act)中的“举报人”条款 Pennsylvania Whistleblower Law. This provision allows a private citizen (referred to as a relator), 如果相关人员知道可能存在虚假索赔,代表政府向某组织或个人提起诉讼. 亲属/举报人可以获得部分和解金. Relators/whistleblowers also have special protection under the qui tam provision of the Federal, NYS and Pennsylvania statutes. 该条款保护雇员不因举报潜在的欺诈活动而受到雇主或雇员的报复.

Pennsylvania Medicaid Fraud and Abuse Control Law

宾夕法尼亚州医疗补助欺诈和滥用控制法(“医疗补助欺诈控制法”)规定了向宾夕法尼亚州医疗补助计划提交虚假或欺诈性索赔的刑事补救措施. 《世界博彩公司十大排名》禁止任何人从事以下行为:

  • 在医疗补助计划下,为提供服务或商品,故意或故意提供虚假或欺诈性的索赔或成本报告,以获得津贴或付款;
  • 在医疗补助计划下,故意为医疗上不必要的服务或商品提出任何索赔或费用报告,以获得津贴或付款;
  • Knowingly submitting false information, 为了获得比他或她在医疗补助计划下依法有权提供服务或商品的报酬更高的报酬;
  • 为获得或提供医疗补助计划下的服务或商品而故意提交虚假信息.

Program Fraud Civil Remedies Act

《世界博彩公司十大排名》(“PFCRA”)规定联邦机构, 包括负责联邦资助的医疗保健项目的机构, 对故意提交虚假索赔的个人和组织进行行政救济, 或者故意制作或者使用虚假的记录或者陈述来获得虚假的赔偿. The PFCRA is limited to situations where a false claim, or a group of related false claims, does not exceed $150,000. The PFCRA provides civil penalties up to $10,781 per false claim, plus an assessment equal to twice the amount of the false claim.

Guthrie’s Commitment to Corporate Compliance

世界博彩公司十大排名诊所致力于完全遵守适用于我们组织的所有法律法规. 企业合规计划是我们以最高诚信经营的承诺的证明. The Compliance Program includes the Code of Conduct, policies and procedures, training and education, auditing and monitoring, 以及让个人提出问题和担忧而不必担心遭到报复的机制.

We ask that you:

  • Act with honesty and integrity in all your business activities.
  • 遵守所有适用于你工作活动的法律法规, including requirements of the Medicare, Medicaid and other federal health care programs. 这些要求通常包括保持完整和准确的医疗记录, 并只提交完整和准确的所提供服务的索赔.
  • 如果您了解或担心潜在的虚假索赔,请联系Guthrie内部的以下资源之一:
    • Director Internal Audit/Compliance – Roger Lathrop, 570-887-5803
    • ComplianceLine – 1-800-841-4644 or ComplianceLink – guthrie.ethicspoint.com

The Guthrie Clinic policy strictly prohibits retaliation, in any form, against an individual reporting an issue or concern in good faith.

感谢您对诚信经营和最高道德行为标准的承诺.