2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Fraud, Waste, and AbuseHistorically, most whistleblowers actually reportedtheir concerns to someone in their workplacebefore they went to the government with the issue.Employees and private citizens can file suit onbehalf of the government. It is important for aprovider to be open and listen to complaints whenone of your staff or patients raise a concern. If youdo not take appropriate action, they will, and theycan receive as much as 30% of the total award ifthe government’s prosecution is successful.New Mexico Whistleblower Protection ActUnder the New Mexico Whistleblower ProtectionAct, a private party brings civil action on behalf ofthe government and allows the government to takeover litigation. If the government wins the case anddamages are awarded, the private party and thegovernment share in the recovery of damages.Effective March 1, 2010, a public employer (anydepartment, agency, office, institution, boardcommission committee, branch, or district of stategovernment) is prohibited from taking retaliatoryaction against a public employee whoCommunicates to the public employer or athird party information about an action or afailure to act he or she believes in good faithconstitutes an unlawful or improper actProvides information or testifies before apublic body as part of an investigation,hearing, or inquiry into an unlawful orimproper actObjects or refuses to participate in an activity,policy, or practice that constitutes an unlawfulor improper actThe act provides for qui tam (whistleblower awards)when a public employer violates the provisions ofthe act. The public employer is liable to the publicemployee forActual damagesReinstatement with the same seniority statusthat the employee would have had but for theviolationTwo times the amount of back pay withinterestCompensation for any special damagesustained as a result of the violationThe employee’s litigation costs andreasonable attorney feesThe employee may bring an action pursuant to thissection in any court of competent jurisdiction.Deficit Reduction Act of 2005See Chapter 3, Eliminating Fraud, Waste andAbuse in Medicaid, Section 6032, EmployeeEducation about False Claims Recovery.Effective January 1, 2007, the Deficit Reduction Actamends the Social Security Act to include requiringany entity that receives or makes annual paymentof at least $5,000,000 under the state Medicaidplan toEducate employees, contractors, and agentsregarding the prevention of Medicaid fraudProvide information in policies and proceduresand the employee handbooks regarding• The federal False Claims Act• Federal administrative remedies for falseclaims and statements15-92014 Practitioner and Provider Manual - Ver. 3