• Submission of a claim for health or medical care services that were never carried out.
• Submission of a claim for services provided to non-existent patients or ghost patients.
• Submission of false service records or samples so as to show a great performance
• Up-coding – submission of a claim for a more expensive service than that which was performed.
• Submission of claims for services or treatments that are not medically necessary.
• There is also the use of double billing. This is just charging the government multiple times for just a service.
False Claims Settlement in Healthcare Setting Every health practitioner and healthcare administrator is familiar with the False Claims Act. If served with a lawsuit under this Act, the survival …show more content…
Some of the top FCA cases are briefly described below:
• GlaxoSmithKline – this pharmaceutical company pleaded guilty in the year 2012 and agreed to pay a whopping sum of $3billion to resolve the criminal and civil liability brought against it. This lawsuit was brought about by the unlawful promotion of a prescription drug the company engaged in, and because the company failed to report the safety data of “Avandia” – a diabetic drug, and also false price reporting. Till date it has remained the largest payment ever made by a drug company (CITATION). GlaxoSmithKline paid for making false and misleading reports about Avandia’s safety.
• Johnson & Johnson – this global healthcare giant paid more than $2.2 billion for resolution of criminal and civil liability from allegations that they were promoting drugs that were not approved for safe uses by the Food and Drug Administration (FDA). Also, for the payment of kickbacks to physicians. Thus, they pleaded guilty to misbranding an antipsychotic drug …show more content…
The company paid $745 million for 5 allegation resolutions, in the same way and manner it billed the U.S government for healthcare costs. The company also paid kickbacks to physicians so as to get referrals of Medicare and Medicaid patients to its facilities. Out of the $745, $95 million went to the resolution of civil claim which arose from the company’s lab billing practices, like billing to Medicare and Medicaid lab tests that were unnecessary medically, and even lab tests that were not ordered by the physician. $403 million went to the resolution of civil claim which arose from up-coding. $50 million went to the resolution of civil claims from illegally claimed marketing and advertising cost, which was disguised as community education. $90 million for the resolution of civil claims in respect of costs incurred in purchasing a home health agency. Lastly, $106 million went to the resolution of civil claims for billing Medicare, Medicaid and TRICARE for giving home visits to those who were not qualified.
Results
The False Claims Act has been effective in the fight against fraud because they give ordinary citizen whistleblowers the privilege to file a lawsuit in all taxpayer’s name. The False Claims Act of 1986 helped the government recover millions of dollars (CITATION). There has been lots of recovery of
• Submission of a claim for services provided to non-existent patients or ghost patients.
• Submission of false service records or samples so as to show a great performance
• Up-coding – submission of a claim for a more expensive service than that which was performed.
• Submission of claims for services or treatments that are not medically necessary.
• There is also the use of double billing. This is just charging the government multiple times for just a service.
False Claims Settlement in Healthcare Setting Every health practitioner and healthcare administrator is familiar with the False Claims Act. If served with a lawsuit under this Act, the survival …show more content…
Some of the top FCA cases are briefly described below:
• GlaxoSmithKline – this pharmaceutical company pleaded guilty in the year 2012 and agreed to pay a whopping sum of $3billion to resolve the criminal and civil liability brought against it. This lawsuit was brought about by the unlawful promotion of a prescription drug the company engaged in, and because the company failed to report the safety data of “Avandia” – a diabetic drug, and also false price reporting. Till date it has remained the largest payment ever made by a drug company (CITATION). GlaxoSmithKline paid for making false and misleading reports about Avandia’s safety.
• Johnson & Johnson – this global healthcare giant paid more than $2.2 billion for resolution of criminal and civil liability from allegations that they were promoting drugs that were not approved for safe uses by the Food and Drug Administration (FDA). Also, for the payment of kickbacks to physicians. Thus, they pleaded guilty to misbranding an antipsychotic drug …show more content…
The company paid $745 million for 5 allegation resolutions, in the same way and manner it billed the U.S government for healthcare costs. The company also paid kickbacks to physicians so as to get referrals of Medicare and Medicaid patients to its facilities. Out of the $745, $95 million went to the resolution of civil claim which arose from the company’s lab billing practices, like billing to Medicare and Medicaid lab tests that were unnecessary medically, and even lab tests that were not ordered by the physician. $403 million went to the resolution of civil claim which arose from up-coding. $50 million went to the resolution of civil claims from illegally claimed marketing and advertising cost, which was disguised as community education. $90 million for the resolution of civil claims in respect of costs incurred in purchasing a home health agency. Lastly, $106 million went to the resolution of civil claims for billing Medicare, Medicaid and TRICARE for giving home visits to those who were not qualified.
Results
The False Claims Act has been effective in the fight against fraud because they give ordinary citizen whistleblowers the privilege to file a lawsuit in all taxpayer’s name. The False Claims Act of 1986 helped the government recover millions of dollars (CITATION). There has been lots of recovery of