Could the service have avoided this situation? Does 4 years of potential fraudulent billing seem a reasonable time period for no one to notice? Yes this situation could have been avoided. This was definitely a system breakdown. It is the responsibility of the healthcare administrator to make sure that mechanisms such as corporate compliance programs put in place to verify accuracy of their organization’s claims. No, 4 years of potential fraudulent billing does not seem to be a reasonable time period for no one to notice. According to Showalter (2012), this standard requires healthcare providers, and their top management and governing board members, to have mechanisms in place to verify the accuracy of their organization’s claims.
What are the consequences of the behavior?
- False Claims Act (FCA) violations range from $5,500 to $11,000 per claim
- Civil penalties
- Criminal convictions
- Loss of participation in Medicare and Medicaid
The threat and the potential for criminal convictions and massive fines have been the major forces motivating healthcare organizations to adopt corporate compliance programs (Showalter, 2012, p. 439).
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Is there a criminal case here? What about civil liability? Are there any non-monetary consequences this Service should now be worried about? Yes, there is a criminal case and a civil liability. Yes, there are non-monetary consequences this Service should now be worried. One non-monetary consequence the Service should be worried about is their reputation that is now under scrutiny and at stake in the community.