On June 30, 2016, the U.S. Department of Justice (DOJ) published an interim final rule which would increase civil monetary penalties assessed or enforced by components of the DOJ. The intent of the rule is to adjust penalty amounts for inflation, as required by the federal Bipartisan Budget Act of 2015.
How might the increase affect health care organizations? Health care providers, among others, would see a twofold rise in penalties assessed for violations of the False Claims Act as well as the Anti-Kickback Act.
Common types of federal healthcare fraud which have been exposed by successful suits under the False Claims Act include charging for services that are not provided or not covered, substandard care, up-coding/unbundling, off-label marketing of prescription drugs, and violations of the Anti-Kickback Act.
False Claims Act Penalties
Penalties for violations of the False Claims Act would range from a minimum of $10,781 to a maximum of $21,563. This represents an increase in the penalty amounts as of Nov. 2, 2015, which ranged from a minimum of $5,500 to $11,000 per claim.
Violations of the False Claims Act include false claims submitted to a government program such as Medicare. Modern Healthcare reports that it is not uncommon for thousands of claims to be at issue in a False Claims Act case.
Anti-Kickback Act Penalties
The interim rule will increase the penalty per occurrence for violations involving kickbacks from $11,000 to $21,563.
Pennsylvania Medical Society (PAMED) members with questions can contact PAMED's Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.