Even the most honest organizations with good-intentioned owners can inadvertently run afoul of the False Claims Act, often due to employee actions or a misinterpretation of government contract obligations. Regardless of the innocence of the mistake, such allegations can tarnish your company’s image. They can also expose you and your enterprise to suspension and debarment, escalating expenses, and pose the risk of civil and criminal penalties.
Complaints under the False Claims Act can be lodged by either the Department of Justice or individuals with information about the fraudulent activity. These are recognized as qui tam claims, incentivizing the submission of False Claims Act complaints by offering the individual up to 30% of the Government’s recovery.
Consequently, businesses should always be ready to handle fraud reports, regardless of their merit. Here are straightforward measures to minimize the likelihood of False Claims Act filings, and to effectively manage any accusations.
Carry Out Compliance Training
Having the best policies and procedures is futile if employees lack the knowledge to integrate them into their daily tasks. While employees might not deliberately breach the False Claims Act, unawareness is no shield against qui tam legal actions. Consequently, alongside establishing a robust policy, your institution should also facilitate frequent compliance education.
The induction of new employees at every level of the organization should involve FCA compliance. It should also be a recurrent feature in retraining sessions, especially given the constant changes in FCA laws and standards.
The training should encompass policies and procedures, billing prerequisites, and patient care. If feasible, it should incorporate real-life examples to enable employees to understand how these laws and policies are relevant to their duties.
Seek Legal Counsel
To ensure your organization aligns with the False Claims Act and prevents qui tam lawsuits, engage legal experts throughout the entire process. Talk to a whistleblower attorney like Oberheiden for legal advice. They can perform risk analyses to highlight possible points of concern. Attorneys experienced in false claims legislation can assist in creating strong policies and educational materials. They also have the capacity to probe controversial claims and provide counsel on challenging issues that surface.
Clear Policies
Your company’s policies play a crucial role in fostering an environment of integrity, fairness, and equality. An open-door policy that promotes the early disclosure of concerns and cultivates a sense of trust is beneficial whenever feasible. Hiring a law firm with expertise in employment law to annually review your personnel policies ensures they are equitable and adhere to the most recent federal, state, and local regulations.
In case your organization faces allegations of unlawful conduct, being able to reference your policy and compulsory training can demonstrate your efforts to comply with the law. If a supposed whistleblower was indeed dismissed for rightful reasons and not as a retaliation for unveiling fraudulent activities, your written policy against such unacceptable behavior serves as critical evidence in your defense against the retaliation allegations.
Overseeing and Managing Violation Reports and Concerns
Many FCA lawsuits stem from dissatisfied employees, both present and past. The Human Resources department should foster an environment where employees feel safe to voice their concerns or report any infractions. These reports and concerns must be investigated and treated with utmost seriousness.
HR should ensure no punitive actions are taken against employees who report issues, which could lead to a separate legal case against the school. The reporting employee should be updated about the progress of the investigation as much as possible; this is to reaffirm that their concerns are being addressed seriously. Ignoring such concerns could potentially push the employee towards becoming a whistleblower and filing an FCA lawsuit.
Endnote
The False Claims Act empowers the government and certain third parties to penalize businesses for deceitful and fraudulent operations. If healthcare providers and systems establish precise and responsible billing methods, they can prevent FCA claims. Upon identifying a billing discrepancy, it should be resolved promptly and openly to evade any complications.
