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Unformatted text preview: really done) 2. Upcoding Legal Effect - depends on the provider's knowledge and intent--> Can violate Criminal Law Category State of Mind Legal Standard Penalty Mistake Honest / Careless Mistake / Negligence None --> Return money Criminal Fraud Intent to defraud Knowing and willfully made false statement Felony = 5 years Beyond a Reasonable Doubt Civil False Claims Act Knowingly presented a false claim Definitions of Knowingly: = Actual knowledge = Deliberate ignorance = Reckless disregard = $5,000-$10,000 + treble damages , with so much at stake it is not worth even a small risk of losing in court so often have to settle...
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This note was uploaded on 04/05/2008 for the course HPAA 310 taught by Professor Deanharris during the Fall '07 term at UNC.
- Fall '07