False Claim Penalties Increase Again

April 10th, 2017 - Wyn Staheli
Categories:   HIPAA|PHI  
0 Votes - Sign in to vote or comment.

On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False Claims Act to provide the government with a more effective way of protecting against false claims and fraud in waste and abuse of federal monies used to fund healthcare programs like Medicare, Medicaid, and TRICARE. At that time, they set the fines at $5,000 (minimum) to $10,000 (maximum) per false claim submitted to these federally funded programs. Since that time, we have seen those penalties first raised to $5,500-$11,000 and just last August (2016) they almost doubled the previous penalty rate, raising them to a minimum of $10,781.40 and maximum of $21,562.80 per claim. 

This new announcement has some people asking "Are these fines and penalties too steep?" Such significant increases in penalties have raised concerns of whether the government has gone too far and whether or not there is recourse under the Eighth Amendment of the Constitution, which states, "Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted." In the 2016 fiscal year ending September 30th, the DOJ obtained more than $4.7 billion in settlements and judgments from civil cases involving fraud and false claims according to Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department's Civil Division.

Looking at these settlement numbers, your organization MUST ask this important question: "Have we implemented a solid compliance plan to address potential risk?" It is essential to have an internal compliance program for your organization, which includes regular auditing of medical records and claims reporting to ensure proper documentation and coding practices are in place. Training and education should be a vital part of the compliance program to aid providers and staff, responsible for documenting and coding medical claims, understand the requirements of these federally-funded healthcare programs.

Getting Help

To learn more about compliance, get our specialty specific Reimbursement Guides and DeskBooks. They offer guidance about important reimbursement issues facing your specialty and the industry as a whole, including documentation standards, common billing problems, and compliance regulations related to these OIG fine increases. CLICK HERE for more information.

Remember: Find-A-Code offers important coding information on the code information page (e.g., NCCI Edits, Cross-A-Code™, Medicare Payer Guidelines, Commercial Payer Policies), as well as helpful tools such as Scrub-A-Claim™.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association