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3 ways the DOJ will use the FCA during the pandemic

| May 15, 2020 | Health Care Investigations |

The government has stated it is prepared to go after those who commit health care fraud to receive funds set aside to help deal with the coronavirus pandemic. True to its word, the Department of Justice (DOJ) has already reported one action against health care fraud related to the coronavirus. The agency states it moved forward with an action against a website offering a free vaccine against COVID-19 – patients need only pay the $4.95 shipping and handling fee. It has since ordered the website to shut down the offer.

As noted in a recent review by the New York Law Journal, the False Claims Act (FCA) will likely play a major role in the DOJ’s fight against health care fraud during the coronavirus pandemic. Three ways the government will use this tool include:

  • Qui tam provision. The qui tam provision within the FCA allows private individuals to bring suit against those accused of health care fraud on behalf of the government. In exchange for coming forward, these whistleblowers will get a portion of the winnings if the case is successful.
  • Scrutiny of payments. The DOJ will carefully review billing from health care providers. It will move forward against those it believes are not billing accurately. This could lead to allegations of “up-coding” or billing for services that were not provided.
  • Review of representations. The government has also gone after universities and labs for false representations of their research findings. Similar allegations could result against those who are looking to find a cure or better testing for the dangerous virus.

The government will likely move forward aggressively against allegations of health care fraud. As a result, anyone who faces such allegations is wise to seek legal counsel.

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