In an earlier column1 summarizing the enhanced anti-fraud provisions enacted in 2010 as part of the Patient Protection and Affordable Care Act (ACA), reference was made to an important provision requiring any person or entity that receives payments from Medicare or Medicaid to disclose and return, within a specified time period, any overpayments that may have been made by those government programs. Four years later, the Department of Justice—apparently for the first time—has intervened in a whistleblower lawsuit in New York alleging that the failure of some hospitals to return Medicaid overpayments within the required time period violates the False Claims Act (FCA)2 and triggers the FCA’s draconian financial penalties.
Background
The FCA imposes fines and penalties when an individual or entity:
…knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the government.3
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