UAMS ADMINISTRATIVE GUIDE
||FEDERAL FALSE CLAIM ACT
This policy applies to all physicians, employees, volunteers, trainees and students of UAMS.
It is the policy of UAMS to obey all federal and state laws, to implement and enforce procedures to detect and prevent fraud, waste and abuse with respect to payments to UAMS from federal and state healthcare programs, and to provide protections for those who report actual or suspected wrongdoing.
Set forth below are summaries of certain statutes that provide liability for false claims and statements. These summaries are not intended to identify all applicable laws but rather to outline some of the major statutory provisions as required by the Deficit Reduction Act of 2005.
The Campus Code of Conduct (UAMS policy number A.5.02) defines specific examples of fraud, waste and abuse. UAMS procedures for education, detection and prevention of fraud, abuse and waste are defined in the UAMS Campus Compliance Program (UAMS policy number A.5.01).
FEDERAL FALSE CLAIMS LAWS
Civil False Claims Act; 31 US Code §§ 3729-3733
- The federal Civil False Claims act imposes civil liability on any person or entity who:
- Knowingly files a false or fraudulent claim for payments to Medicare, Medicaid or other federally funded health care program;
- Knowingly uses a false record or statement to obtain payment on a false or fraudulent claim from Medicare, Medicaid or other federally funded health care program; or
- Conspires to defraud Medicare, Medicaid or other federally funded health care program by attempting to have a false or fraudulent claim paid.
- Actual knowledge that the information on the claim is false;
- Acting in deliberate ignorance of whether the claim is true or false; or
- Acting in reckless disregard of whether the claim is true or false
A person or entity found liable under the federal Civil False Claims Act is subject to a civil money penalty of between $5000 and $11,000 plus three times the amount of damages that the government sustained because of the illegal act. The amount of damages in health care terms is the amount paid for each false claim that is filed.
Anyone may bring a qui tam, or Whistle-blower, action under the federal Civil False Claims Act in the name of the United States in federal court. The case is initiated by causing a copy of the complaint and all available relevant evidence to be served on the federal government. The complaint remains sealed for 60 days and will not be served on the defendant so that the government can investigate the complaint. The government may obtain additional investigation by showing good cause. After expiration of the review and investigation period, the government may pursue the matter in its own name or decline to proceed. If the government declines to proceed, the person who filed the action has the right to continue with the case.
If the government proceeds with the case, the person bringing the action will receive between 15% and 25% of any recovery, depending on the contribution of that person to the success of the case. If the government does not proceed with the case, the person bringing the action will be entitled to between 25% and 35% of any recovery, plus reasonable expenses and attorney’s fees and costs.
- Arkansas Code Annotated § 21-1-601 through 609
- Federal False Claims Act, 31 USC § 3279
- Deficit Reduction Act of 2005 (S. 1932)