Corporate Responsibility - Ascension Health

L A W S A N D R E G U L A T I O N SWe create accurate and truthful patient bills and submitaccurate claims for payment from any payer, includingMedicare and Medicaid, commercial insurance or ourpatients. Not only is it the right thing to do, but federaland state laws require accuracy in healthcare billing.The False Claims Act is a federal law that makes it acrime for any person or organization to knowingly makea false record or file a false claim with the governmentfor payment. “Knowingly” includes having actualknowledge that a claim is false, or acting in “deliberateignorance” or “reckless disregard” as to whether a claimis false. Examples of possible false claims include billingFinancial penalties to the organization for submitting afalse claim can total as much as three times the amountof the claim plus fines of $5,500 to $11,000 per claim.In addition to fines and penalties, an individual ororganization that violates the False Claims Act issubject to exclusion from participation in federallyfunded healthcare programs.C O R P O R A T E R E S P O N S I B I L I T YMedicare for services that were not provided, billing fora higher-level service than the service actually furnished(upcoding) or billing for services that were not orderedby a physician.The False Claims Act contains provisions that allowindividuals with original information (i.e., information notalready the subject of legal proceedings or activitiesthat have already been publicly disclosed) concerningfraud involving government programs to file a lawsuiton behalf of the government and, if the lawsuit issuccessful, to receive a portion of recoveries obtainedby the government.