Other Compliance Offices:
  Billing Compliance Home
  Billing Manual & Policies
 

Billing Compliance News

  Regulations Update
  Clinical Trial Resources
  Physician Alerts
  Compliance Week
  FAQ
  Training
  Compliance Online Training
  False Claims Act
  ICD-10
  DMERC
  Informational Web Links
  General Forms
  Coding Resources
  Insurance Directives
 

Billing Compliance Newsletters

  Contact Our Office
  Archived Articles & Information

 

HIPAA Homepage
  Compliance Office Home
  OUHSC - Home
  OU - Norman Home
  OU - Tulsa Home

FAST LINKS

Standards of Conduct

Guidance on Stark Law

False Claims Act Report

Anti kickback Law & Safe Harbor Fact Sheet

Antidumping Bulletin

Compliance Guidance

Supervising Physicians in Teaching Settings

DMERC

 

 

 

 

 

 

 

 

Do you have any questions or concerns that are not answered on this site?  Would you like to be notified when this site is updated?
Email Compliance:

billingcompliance@ouhsc.edu

False Claims Act

Contained below is information on both the federal and state false claims act (FCA).  The federal FCA has been in effect since 1863, however, dormant until it was revised in 1986 by Congress.   The original Oklahoma State FCA became effective November 1, 2004, however, it was recently updated.  The new revision became effective November 1, 2007 and directly addresses Medicaid payments.

Our office is available to present group or individual training sessions on the FCA to all employees upon request.


Federal False Claims Act

Summary:  The False Claims Act 31 U.S.C. sec. 3729-3733, protects the federal government against fraud and abuse.  Under the False Claims Act (FCA), anyone who knowingly submit, or causes another person or entity to submit, or knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approval of government funds are liable for three times the government's damages plus civil penalties of $5,500 to $11,000 per false claim.

The term "knowingly" means that a person:

1.  has actual knowledge of the information;

2. acts in deliberate ignorance of the truth or falsity of the information; or

3. acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.


The FCA contains qui tam, or whistleblower, provisions which allow anyone with evidence of fraud to sue on behalf of the government, in order to recover overpayments of federally funded health care programs.  The Department of Justice can investigate and decide whether to join the action.  If the government elects not to intervene, the qui tam relator may proceed with the action.  The whistleblower may be awarded a percentage of the recovered funds.


For a further information on the FCA for OU/OUHSC, please click on False Claims Act
For further details, access Department of Justice resources on the False Claims Act, click on the link(s) below -

False Claims Act Title 31

False Claims Report

 


Oklahoma State False Claims Act
The Oklahoma State false claims act (FCA) was updated on May 8, 2007 to create provisions related to Medicaid reimbursement for professional services.  The updated FCA became effective November 1, 2007.  The revisions were due to the Deficit Reduction Act (DRA) of 2005.  The DRA has made Medicaid Fraud and Abuse compliance programs mandatory for many organizations.  The DRA mandates that any entity which receives at least $5 million in Medicaid payments per year must implement employee education programs and policies related to Medicaid fraud and abuse.   Under the state FCA, any person who:

    1. knowingly presents, or causes to be presented, to an officer or employee of the State of Oklahoma, a false or fraudulent claim for payment or approval;
    2. knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the state;
    3. conspires to defraud the state by getting a false or fraudulent claim allowed or paid;

The term "knowingly" means that a person:

        1.   has actual knowledge of the information;

        2.   acts in deliberate ignorance of the truth or falsity of the information; or

       3.  acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.

In the state FCA, civil penalties for false claims are similar to those addressed in the federal FCA.   The State FCA also has established statutes of limitations as to the length of time an individual may pursue false claims issues.   To access the entire statute, please click on State False Claims Act.

Please note the Oklahoma Health Care Authority (OHCA) has developed a web-based education on false claims.  To access their program, you will need to go to the Oklahoma Learning Management System by clicking on the following link - www.oklms.org and register as a new user.  For more details, please click on OHCA false claims program.


Would you like to be notified when this site is updated?  Please send an email to the Billing Compliance Office & we'll add you to the list.  Click here to send email to us.

Back to Top

Healthcare Billing Compliance Office

Oklahoma City -
920 Stanton L. Young Blvd
Williams Pavilion, Ste 1230
Oklahoma City, OK 73104
Telephone: 405-271-1528
Fax: 405-271-2499

 

Tulsa -
4502 E 41st  ST, Ste 2G02
Tulsa, OK 74135
Telephone: 918-660-3627
Fax: 918-619-4058


For Healthcare Billing Compliance website problems, please contact
the
Website Curator 

Would you like to be notified when this site is updated?  Please send an email to the Healthcare Billing Compliance Office & we'll add you to the list.  Click here to send an email to us.

Last update 09/10/2013


This web site Designed and Built by Information Design Services a department of the University of Oklahoma Health Sciences Center.

Every effort will be made to update the information contained on these pages as necessary. However, it is the responsibility of the user to determine that he or she is relying on the most current version of any particular information. Any questions about the material should be directed to the referenced office or department.
    
Copyright © 2003 The Board of Regents of the University of Oklahoma, All Rights Reserved.
Disclaimer | Copyright