Provider Relief Funds: Potential Enforcement Action for False Claims

The following article is about potential liability under the False Claims Act based on receipt of funds from the Provider Relief Fund. 

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The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) announced a strategic plan for oversight of COVID-19 response and recovery on May 26, 2020. The Plan includes four goals:
  • Protect people
  • Protect funds
  • Protect infrastructure
  • Promote effectiveness
Providers who receive funds from the Provider Relief Fund are especially concerned about the OIG's efforts to protect funds. The OIG has, of course, officially announced its intention to audit recipients of payments from the Fund. The terms and conditions of the Fund make it clear that full compliance is required. Non-compliance is grounds to recoup some or all of the payments made from the Fund. Therefore, failure to comply with all terms and conditions may result in repayment of the monies received.
Non-compliance with all terms and conditions may also result in allegations of false claims under the Federal False Claims Act. The False Claims Act includes these types of violations:
(1)       knowingly and willfully makes or causes to be made any false statement or a representation of a material fact in any application for any benefit or payment under this subchapter,
(2)       at any time knowingly and willfully makes or causes to be made any false statement or representation of material fact for use in determining rights to any such benefit or payment,
(3)       having knowledge of the occurrence of any event affecting (A) the initial or continued right to any payment, or (B) the initial or continued right to any such benefit or payment of any other individual in whose behalf he has applied for or is receiving such benefit or payment, conceals or fails to disclose such event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized, or
(4)       having made application to receive any such benefit or payment for the use and benefit of another and having received it, knowingly and willfully converts such benefit or payment or any part thereof to a use other than for the use and benefit of such other person..."
The terms and conditions for receipt of funds include language that says that "any deliberate omission, misrepresentation, or falsification of any information contained in this Payment application or future reports may be punishable by criminal, civil, or administrative penalties." Possible adverse action includes revocation of billing privileges in the Medicare Program and/or exclusion from all federal and state health care programs.  
This statement certainly clarifies that the application for funds and subsequent reports filed may be treated as false claims under the False Claims Act.  Careful completion of all documents related to funds received is clearly important.
©2020 Elizabeth E. Hogue, Esq.  All rights reserved.


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