Medicaid and Medicare Violations:
Violations of Medicare laws and the Medicare Fraud and Abuse Statute also constitute
violations of the False Claims Act. Hospitals, nursing homes, doctors, home health
care agencies, durable goods providers, pharmacies, and laboratories that seek and
receive reimbursement for Medicare and Medicaid funds are Government contractors
subject to the False Claims Act.
Healthcare workers and families of nursing home or hospital patients should pay
particular attention to the services provided. Not only can this improve the healthcare
for patients and loved ones, but it also helps ensure that public Medicare and Medicaid
monies are properly spent in accordance with the law and good medical practice.
Billing for services not rendered, misrepresenting the type of goods or services
rendered, or misrepresenting the nature of the patient's illness can trigger liability
under the False Claims Act. Likewise, failing to provide correct data on annual
hospital or nursing home cost reports that must be provided to the Government will
violate the law, if the errors were done knowingly or intentionally. In addition,
hospitals and nursing homes that provide substandard care may also be in violation
of the False Claims Act.
Pharmacy-related violations could include the following:
1. Partially filling prescriptions, but charging as if a full prescription was
provided.
2. Providing kickbacks to a medical provider in order to induce the provider
to prescribe certain drugs.
3. Prescribing unneeded medications, drugs, or treatment that are not a medical
necessity.
4. Charging Medicare or Medicaid patients a higher rate than others for the same
prescription.
5. Knowingly providing defective products or services.
6. Falsely diagnosing a more severe ailment than the one the patient actually
has, known as "upcoding" a diagnosis, thereby justifying a more expensive drug therapy
or other treatment than that which the patient's health really requires.
7. Inappropriate changes in patients' prescriptions from one drug to another
as a result of kickbacks or for other improper reasons.
8. Falsely reporting drug research grant information to government agencies.
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