False Claims Act

PeaceHealth is required by federal law to provide information to all its contractors and agents regarding the federal false claims act, administrative remedies for false claims and statements, the state false claims act and whistleblower protections under these laws. The federal and state false claims acts play an important role in detecting fraud, waste and abuse in federal health care programs. Please provide this information to all employees.

The False Claims Act – A Federal Law That Protects Whistleblowers

The law. The federal False Claims Act (31 USC 3729-33) makes it a crime for any person or organization to knowingly make a false record or file a false claim with the government for payment. “Knowing” means that the person or organization:

  • knows the record or claim is false, or
  • seeks payment while ignoring whether or not the record or claim is false, or
  • seeks payment recklessly without caring whether or not the record or claim is false.

Under certain circumstances, an inaccurate Medicare, Medicaid, VA, Federal Employee Health Plan or Workers’ Compensation claim could become a False Claim. Examples of possible False Claims include someone knowingly billing Medicare for services that were not provided, or for services that were not ordered by a physician, or for services that were provided at sub-standard quality where the government would not pay.

A person who knows a False Claim was filed for payment can file a lawsuit in Federal Court on behalf of the government and, in some cases, receive a reward for bringing original information about a violation to the government’s attention. Some states have a False Claims Act that allows a similar lawsuit in state court if a False Claim is filed with the state for payment, such as under Medicaid or Workers’ Compensation. Penalties are severe for violating the federal False Claims Act. The penalty can be up to three times the value of the False Claim, plus from $5,500 to $11,000 in fines, per claim.

Whistleblower protections. The federal False Claims Act protects anyone who files a False Claim lawsuit from being fired, demoted, threatened or harassed by their employer for filing the suit. An employee who was harmed by their employer for filing a False Claims lawsuit must file a lawsuit against their employer in Federal Court. If the employer retaliated, the court can order the employer to re-hire the employee, and to pay the employee twice the amount of back pay that is owed, plus interest and attorney’s fees.

Our Policy. PeaceHealth’s Organizational Integrity Program includes monitoring and auditing for compliance that helps prevent or detect errors in coding or billing. 

  • PH expects that our employees who are involved with creating and filing claims for payment for services that we provide will only use true, complete and accurate information to make the claim.
  • PH expects that anyone with a concern about a possible False Claim at a PH facility will use the OI Reporting Process immediately so that PH can investigate and correct any errors.
  • PH’s policy on non-retaliation protects our employees from adverse action when they do the right thing and report any genuine concern via the OI Reporting Process.
  • PH will investigate any allegation of retaliation against an associate for speaking up, and will protect and/or restore rights to anyone who raised a genuine concern.

Our Promise. Our employees work hard to ensure that every claim for payment for the care we provide is correct and accurate, so that we do not violate the law, or break the trust we maintain with our patients and communities.

If you have any questions about this information or wish to report a concern or view policies related to our Organizational Integrity Program, please contact Gary Chiodo, vice president of Organizational Integrity, at 360-729-1891 or e-mail: GChiodo@peacehealth.org