As most medical practices are aware, the government is the largest healthcare payer in the United States, and the country works hard to protect the funds that go out to pay for medical services and procedures. One way that goal is achieved is through the False Claims Act, a law that allows the government to examine practices’ claims to determine that they aren’t submitting anything fraudulent. And one aspect of the False Claims Act that many practices aren’t aware of is the concept of reverse false claims.
Check out the key facts that every provider must know about reverse false claims so you can stay on the straight and narrow.
The Importance of Refunds
When most medical practices think of False Claims Act (FCA) violations, they envision making a false statement to the government that causes the government to then pay your claim. While this is definitely an example of an FCA violation, there are other common liability provisions, one of which is called a reverse false claim. This occurs when you get payment from the government, and you subsequently find out that you shouldn’t have been paid that amount.
You have an obligation as a healthcare provider under the Affordable Care Act to refund any identified overpayments. And if you know that you have an overpayment but you keep it instead of returning it, that’s what’s called a reverse false claim.
By keeping a refund that you’re not entitled to, you are in violation of the False Claims Act, which could result in not only a request back for that money, but also treble damages, which are three times the amount of the improperly paid amounts. That’s on top of penalties that the government can incur as well, leading to potentially thousands that you’d have to pay back if you’re found in violation of a reverse false claims accusation.
Have a Process to Avoid Reverse False Claims
The best way to ensure that you aren’t creating reverse false claims violations is to perfect your accounts receivables strategy and identify overpayments immediately. To add a second layer to ensure you have a foolproof way to catch overpayments, create an internal audit schedule where you review all of your records and payments on a particular cadence. Determine whether you’ve overcoded, unbundled, or done anything else that would result in you receiving an overpayment or duplicate payment.
You have 60 days to report and return the overpayment once you identify it, or after the government notifies you that you owe one. Don’t hesitate to respond if you ever receive a notice requesting funds back, and if you’re ever in doubt about whether you actually owe the money or you need to dispute it, always contact a qualified healthcare attorney to help you sort through the issue.
Shore up your compliance plan and avoid reverse false claims with tips from expert Amanda Waesch, Esq. During her latest online training event, Protect Against New False Claims Act Penalties, Amanda shares the exact steps you must take to protect your practice. Register today!
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