ACA Allows Feds to Step Up Fight Against Health Care Fraud

There’s a lot more to the Affordable Care Act than the individual mandate and insurance-related matters. Of particular note: provisions that relate to the government’s efforts to identify and prosecute health care fraud and abuse. From law firm Saul Ewing:

“Under ACA, HHS is now permitted to suspend Medicare and Medicaid payments to a health care provider pending an investigation of a ‘credible allegation of fraud,’ which includes anonymous fraud hotline complaints (including ‘whistleblowers’), patterns identified through data mining and investigations under the False Claims Act. These suspensions are for a ‘maximum’ of 18 months, and can be extended if administrative action is pending or being considered by OIG, or if DOJ requests an extension based on an ongoing investigation and an anticipated or pending criminal prosecution or other action. As such, the length of these suspensions is effectively unlimited and leaves providers in a very difficult position. In some circumstances, going out of business or a settlement may be the only options available to a provider that has had its payments suspended.”

Read the full update, Fraud and Abuse Issues Under the Affordable Care Act - Saul Ewing LLP»