Healthcare is one of the most heavily regulated industries in the United States. Especially with federal funding like Medicare or Medicaid, violations of the strict guidelines around service and billing procedures come with hefty fines. In the fiscal year 2018, the Department of Justice recovered over $2 billion in settlements and judgments from healthcare companies or facilities that had committed fraudulent billing behavior per the False Claims Act. This act deals with services claimed (billed) per the minute in some cases, so accuracy in all aspects of billing is key.

In Indiana, the False Claims Act outlines fees of up to three times the value of the false claim plus up to $11,000 per claim. With such hefty stakes, make sure your facility is aware of the ways to reduce your liability concerning the False Claims Act.

  1. Write and enforce a robust False Claims Act training policy for all employees. Aside from the compliance requirement to train all employees on key aspects of the False Claims Act, it is also a smart business practice. The False Claims Act governs claims that were knowingly falsified, and it also handles claims that the healthcare provider or government oversight agency should have known were incorrect. A lack of knowledge about service or billing procedures represents a large liability. Additionally, this training should educate employees about the agency’s procedure for reporting False Claims Act concerns.
  2. Keep up to date with all service definitions and codes. Medicare and Medicaid narrowly define which services healthcare providers can bill to federal and state funding. Train all providers to reference the service definitions when documenting services rendered to Medicare or Medicaid patients.
  3. Maintain a strong audit system for accounting protocols. Human error happens. A typo on a billing document is not grounds for a False Claims Act settlement. However, agencies that are unable to reconcile their claims each fiscal year are at a higher risk for legitimate billing issues slipping through the cracks. Report and correct billing errors early and often.

All healthcare providers are responsible for using federal and state money appropriately. These measures help make that happen.