assigment 2. False Claim Acts.docx - FALSE CLAIMS ACT...

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FALSE CLAIMS ACT University of Maryland University College False Claims Act July 14,2020 HMGT 372 6981 Professor Dr. Karen Keune 1. Name of the Law and or laws:
2 FALSE CLAIMS ACT According to the United States Department of Justice (2020), False Claims Act 31 U.S.C. §§ 3729 - 3733, a federal law originally enacted in 1863 by a Congress concerned that suppliers of goods to the Union Army during the Civil War were defrauding the Army. This law that acts against any person or organization that knowingly make false record or file false claim regarding any healthcare program that provides health benefit via insurance or not or that is funded directly by the united states government or any state healthcare system. Anybody that committed false claims act was liable for double of the government damages and a penalty of $2,000 for each claim act. The false claims act had been amended several times and know provides that violators are responsible for triple damages plus a penalty. 2. Management’s Financial Responsibilities: “Civil monetary penalties law (CMPL) 42 U.S.C. Section 1320a-7a authorizes OIG to seek CMP’s and sometimes exclusions for a variety of healthcare fraud violations. Different amount of penalties and assessment apply based of the violation”. (MEDICARE FRAUD & ABUSE: PREVENT, DETECT, REPORT, 2019, p 10). Agency management has the responsibility to the consumers and the payors to report all abnormalities. Managers are responsible for the documentation submitted as claims to the insurance companies for payments. Good documentation help to guarantee that the patient is receiving the appropriated care. The managers are responsible to make sure that the service provided is medically necessary for the patient, that the services is cost effective and that there is high quality care for the patient. Managers are also responsible to identify the services delivered and be able to describe the services rendered to the consumer. Again, the documentation is the key to help address any issues that might raise about the integrity of the claims. 3. Consequences for Ethical or Legal Breach:
3 FALSE CLAIMS ACT Violations under the federal false claims act can result in significant fines and penalties.

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