Cooperation With Feds Can Pay Off When Facing False Claims Act Allegations

Jacksonville-based Baptist Health System has agreed to pay $1.5 million to resolve allegations that it violated the False Claims Act and the Civil Monetary Penalty Law.

It was alleged that Baptist provided discounts of 50 percent or more on balances patients owed for certain categories of Medicare beneficiaries, chosen by Baptist Health, without regard to whether there was a financial need. The violations are alleged to have occurred from Jan. 1, 2016, through Aug. 15, 2022.

In certain instances, patients must share the cost of medical care – this is considered cost sharing. This generally includes deductibles, coinsurance, and copayments, or similar charges,

The government contents that Baptist Health subsidiaries provided these discounts in exchange for the beneficiaries’ purchase or referral of services by certain categories of Medicare beneficiaries from Baptist Health subsidiaries.

The False Claims Act provides that any person who knowingly submits, or causes to submit, false claims to the government is liable for three times the government’s damages plus a penalty. The Anti-Kickback Statute prohibits offering kickbacks for referrals in federal healthcare programs. The Office of Inspector General (OIG) has the authority to seek civil monetary penalty assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct.

Self-disclosure Can Save Healthcare Entities Time and Money

Baptist Health voluntarily self-disclosed its actions to the government, cooperated with the government’s False Claims Act investigation and took remedial measures. They included discontinuing its discount policy, conducting an internal compliance review and providing the government with a detailed disclosure statement and other supplemental information to assist in the investigation.

By self-disclosing its violations of the False Claims Act, Baptist was able to mitigate the consequences. However, according to the settlement agreement Baptist does not admit to the allegations.

Baptist Responds to False Claims Act Allegations

Baptist issued the following statement: “Upon review of its payment practices, Baptist Health made a voluntary self-disclosure of outdated courtesy discount practices. The self-disclosure process encourages transparency and facilitates the resolution of matters that potentially violate federal laws, and it aligns with our commitment to do the right thing. This settlement reaffirms our dedication to compliantly delivering high-quality care.”

Settlement Serves as Example

The settlement serves as an example of how important it is for healthcare entities to self-regulate. In this False Claims Act violation case, by self-reporting its actions Baptist avoided a lengthy and expensive prosecution.

“We encourage providers to mitigate the consequences of prior improper conduct by making timely self-disclosures, cooperating with our investigations and adopting enhanced compliance procedures,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, in a news release.

Added U.S. Attorney Roger B. Handberg for the Middle District of Florida: “Self-disclosures like this not only help crucial federal healthcare programs to recoup funds but are also in the best interests of healthcare providers themselves.”

How to Self-disclose Healthcare Violations

The Office of Inspector General (OIG) has several self-disclosure processes that can be used to report potential fraud. Healthcare providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties can use the Provider Self-Disclosure Protocol, to voluntarily disclose self-discovered evidence of potential fraud.

How We Can Help

The Health Law Offices of Anthony C. Vitale can help you to develop an effective program that allows you to identify and correct any potential violations before you become the target of an investigation.

If you or your company are the subject of an investigation, an effective compliance program may help you mitigate or eliminate potential sanctions, penalties, and program exclusions.

Because the healthcare regulatory environment is complex and in constant flux, you need a team of experienced attorneys who stay up to date with the most recent changes.

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