HHS-OIG Releases Summary of Anti-Fraud Provisions in Health Care Reform Bill
Expansion of the Recovery Audit Contractor (RAC) program, increased penalties under federal sentencing guidelines and heightened program integrity measures are just a few of the new anti-fraud provisions found in the Patient Protection and Affordable Care Act (PPACA).
This week Lew Morris, counsel for the Department of Health and Human Services-Office of the Inspector General, released a chart outlining the fraud and abuse/program integrity provisions in the PPACA, many of which took effect on the date of enactment (i.e. March 23, 2010) and require prompt compliance attention.
Some of the new provisions merely confirm long standing legal positions - for example, the PPACA amends the federal Anti-Kickback statute (AKS) to define a "false claim" under the federal False Claims Act as any claim that includes items or services resulting from a violation of the AKS. However, federal courts had long adhered to this position when deciding FCA cases.
However, other new changes should be carefully noted by providers - for instance, one of the amendments which may have the greatest impact on the health care industry is the relaxed "specific intent" requirement under the AKS. Importantly, the amendment provides that an AKS violation may be established without showing that an individual kew of the statute's provisions and intended to violate the statute. Previously, conviction for an AKS violation required proof of intent.
As another example, the PPACA requires that Medicare overpayments must be reported and returned within 60 days of identification or the date a corresponding cost report is due, whichever is later. Any overpayment retained after the 60-day deadline is considered an obligation for purposes of the FCA.
Providers are well-advised to carefully review the fraud and abuse summary, and contact an attorney to update compliance plans and manuals.
