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GOVERANCE AND FRAUD IN HEALTH CARE ORGANIZATIONS LEGAL AND ETHICAL RESPONSIBILITIESCONFIDENTIALITY HMGT 372 LEGAL AND ETHICAL ISSUE IN HEALTHCARE SUBMITTED TO PROFESSOR NICOLE MAZZEI-WILLIAMS Mervyn Riley FALL 2018
RUNNING HEAD: FALSE CLAIMS ACT 1 Name of the Law and or laws The False Claims Act (FCA), 31 U.S.C. §§ 3729 - 3733 is both a Federal and State law which was legislated in 1863 by the United States Congress. The FCA requires that anyone who knowingly submitted fraudulent or false claims to the government was liable for double the government’s damages plus a penalty for each false claim. Also, the FCA includes provisions for both criminal and civil liability, holding perpetrators responsible for a variety of forms of conduct that are rooted in fraud which might result in financial loss to the United States. The criminal provision carries up to five years imprisonment and fines of up to $250,000 for any person who "makes or presents . . . any claim upon or against the United States, or any department or agency thereof, knowing such claim to be false, fictitious, or fraudulent." 18 U.S.C. § 287” (Reckler et al 2012). Management’s Financial Responsibilities: Kick Back Patients reserve the right to trust that their healthcare providers put their care ahead of any financial gain. It is for this reason that specific laws and statutes exist. Furthermore, the health care management’s financial responsibility involves maintaining ethical and legal practices with every patient referral. Tony Munter, a whistle blower Qui Tam attorney, explains that Medicare and Medicaid providers are prohibited from receiving kickbacks in exchange for referring patients, performing certain procedures, or prescribing certain drugs. More specifically, the Anti-Kickback Statute, 42 U.S.C. Section 1320a-7b(b), prohibits anyone from offering,
RUNNING HEAD: FALSE CLAIMS ACT 2 soliciting, paying, or receiving anything of value (including referrals) in exchange for referring patients, performing procedures, or using/prescribing products that will in any way be paid for by any federal health care program like Medicare or Medicaid (Munter n.d). Knowing that conviction for a single violation under the Anti-Kickback Statute may result in a fine of up to $25,000 and imprisonment for up to five years should be adequate incentive for management to ensure that anti-kickback laws are respected with every interaction to avoid such fines. Another responsibility for the financial management is to protect the interest of the institution because convictions in violations of Anti-kickback laws can result in mandatory exclusions in federal health programs 42 U.S.C. § 1320a-7(a) (Sabella n.d). Furthermore, the financial management has the responsibility to realize that improper payments can come in many different forms, including, but not limited to: referral fees, finder’s fees, productivity bonuses, discounted leases, discounted equipment rentals, research grants, speaker’s fees, excessive compensation, and free or discounted travel or entertainment. Keeping

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