MedStar Ambulance will pay $12.7 million to settle allegations made by a whistleblower through the False Claims Act that it had knowingly submitted false Medicare claims, according to the Department of Justice.
Details of the allegations suggest MedStar routinely billed Medicare for transports that were not medically necessary or for higher levels of services than were provided between 2011 and 2014.
- More than half (($2.6 billion) of the $4.7 billion recovered by the government through the False Claims Act in 2016 were from the healthcare industry, the National Law Review reports.
The False Claims Act is increasingly relied upon to identify attempts to defraud Medicare and Medicaid. The government stepped up efforts in 2016 to recover money doled out due to fraud and those efforts are paying off.
The legislation has been around since the 19th century, though the government has only more recently used it to target those who attempt to defraud the government, according to the National Law Review. The DOJ's civil division has recovered more than $29.9 billion through False Claims Act cases since 2009, and upwards $18.3 billion of that amount involved fraud against federal healthcare programs.
While the Obama administration appeared to have favored using the legislation as a tool to combat fraud, the incoming Donald Trump administration could discard it. However, the National Law Review's Joe Harper and Jaci Overmann urge a cautious approach. “It is imperative that companies doing business with the government have robust False Claims Act and whistleblower compliance programs and policies in place at all levels of the corporate structure,” they wrote.
Venson Wallin, consulting managing director at accounting firm BDO, recently offered advice on three areas that could help to prevent fraud: measuring and monitoring, reviewing compliance programs, and evaluating contracts and networks.