What to do about our unqualified MDS coordinator?

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Attorney John Durso, Ungaretti & Harris LLP
Attorney John Durso, Ungaretti & Harris LLP
We hired an unqualified MDS coordinator who filed many claims for us at too high of a reimbursement rate and now we're being pursued under False Claims Act charges. How do we get out of this mess?

If you are currently aware that your organization is being investigated for a violation of the False Claims Act, then you should, if you haven't already, consult with an attorney who has experience handling both civil and criminal healthcare fraud matters and the False Claims Act.

Among all of the healthcare fraud and abuse laws, the False Claims Act is probably the one that is best known for keeping facility executives up at night. To calculate potential penalties, triple the amount you have been overpaid and then tack on potential penalties of more than $5,000 per claim.

Your attorney will address the specifics of your situation. As a general matter, though, it is likely that there are steps you can be taking now to reduce your organization's exposure.

Attorneys with experience in this area likely will advise you as to how you should carefully proceed with things such as document retention, interactions with your employees, internal investigations and inquiries from enforcement agencies or other government officials.

The Patient Protection and Affordable Care Act enhanced the power of the government to invoke the False Claims Act. For example, if your organization knowingly retains an overpayment for more than 60 days without contacting the appropriate agencies, it could give rise to liability under FCA. Self-reporting known overpayments has proven effective in ultimately reducing FCA liability, but it sounds like it may be too late for your organization to pursue that option.
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