On December 4, 2020, the Department of Health and Human Services (HHS) announced the establishment of a False Claims Act Working Group that intensifies its partnership with the Department of Justice (DOJ) and the HHS Office of Inspector General (OIG) to combat fraud and abuse. In close coordination with DOJ and OIG, the Working Group seeks to protect government funds by identifying potential False Claims Act violations and referring them to DOJ and OIG. The Working Group will also assist the DOJ and OIG in False Claims Act actions by providing an HHS views on the intricate legal frameworks of the agency’s numerous funding programs.
The HHS is in an exclusive position to work with the DOJ to identify and assess potentially fraudulent activities. HHS is the agency administering various programs involving the payment of significant amounts of money to private parties. The HHS Office of the General Counsel (OGC) created the False Claims Act Working Group to strengthen the working relationship with DOJ. The Working Group is comprised of former DOJ False Claims Act and healthcare fraud prosecutors, former private counsel for healthcare and life sciences companies, and HHS attorneys with extensive experience with HHS’ most vulnerable payment programs.
The Working Group will also provide targeted training to the HHS programs that are most vulnerable to fraud and abuse. The trainings will allow OGC attorneys and HHS program operators to better detect and refer potential false claims to DOJ and OIG. While working with the OIG, the Working Group will also provide a focal point within the agency for consultation about legal requirements and recommendations about alleged violations.
Compliance Perspective
Issue
It is imperative that all staff members are aware of what can be considered a false claim. Appropriate staff should be trained on complete and accurate documentation that supports submitted claims, including how inaccurate or incomplete documentation can lead to a false claim.
Discussion Points
- Review policies and procedures on how to prevent or detect submission of a false claim.
- Educate staff on requirements for accurate claims submission and the necessity for supporting documentation. Teach staff working in the claims submission process about what may be considered a false claim and how to avoid submitting one.
- Periodically audit claims to ensure that they are accurate and that there is supporting documentation for each claim.
FOR MORE INFORMATION ON THIS TOPIC view: UNDERSTANDING AND USING THE MEDICARE TRIPLE CHECK PROCESS.
