According to the Patient Protection and Affordable Care Act of 2010, anyone who receives an overpayment of Medicaid or Medicare funds report is required to pay back the amount of the overpayment within 60 days of when the problem was discovered and identified. The failure to repay is considered a violation of the False Claims Act. But what exactly does it mean to “identify” the presence of a false claim?
One recent court decision in the Southern District of New York addressed this exact issue. The case, Kane v. Healthfirst, et al and U.S. v. Continuum Health Partners Inc., et al, involved claims that Continuum, which coordinated and operated a large network of non-profit medical facilities, had failed to repay its identified overpayments in a timely manner.
Auditors from the state of New York uncovered the potential false claim in September 2010. A Continuum employee then provided a list of possible overpayments to the company’s management team the following February. The company fired him four days later, so he filed a whistleblower action. Continuum did not begin returning overpayments until June 2012, after the government initiated a Civil Investigative Demand, and finally paid off the overpayments in full in May 2013.
The ruling in the New York court case stated that about half of the list of overpayments the employee provided in 2011 were indeed considered overpayments. Although Continuum argued the 60-day period to repay should have begun when the overpayment was classified with 100 percent certainty, the court sided with the government, ruling that the 60-day window began as soon as the company was put on notice.
If you are aware of False Claims Act violations in your workplace, consult the trusted Dallas attorneys at Whistleblower Law for Managers for the sound legal guidance you need.