As a condition of receiving certain payments under Medicaid, Achieve Beyond must comply with Section 6032 of the Deficit Reduction Act of 2005 (“DRA”), which requires Achieve Beyond to ensure that all employees, contractors, and agents receive detailed information regarding federal and state false claims laws and the role of those laws in preventing and detecting fraud, waste, and abuse.
PolicyIt is Achieve Beyond’s policy to provide the fraud and abuse education required under the DRA to its employees, contractors, and agents. Specifically, Achieve Beyond will provide all employees, contractors and agents with detailed information about:
To: Achieve Beyond employees and others affiliated with Achieve Beyond
From: Joseph Matuza, Corporate Compliance Officer
Date: November 2021
RE: Compliance Program and Federal Deficit Reduction Act
Achieve Beyond is committed to preventing and detecting fraud, waste and abuse. In support of this commitment, Achieve Beyond has established a Corporate Compliance Program. The purpose of the Corporate Compliance Program is to establish appropriate controls that will help ensure consistent compliance with the federal and State laws which govern our activities, and to detect violations of the law by employees and others affiliated with Achieve Beyond.
Elements of Achieve Beyond’s Corporate Compliance Program include:
A goal of the Corporate Compliance Program is to educate appropriate employees with respect to federal and State statutes and regulations with which they must comply. In this regard, the federal Deficit Reduction Act (“DRA”) requires Achieve Beyond to provide all employees, contractors or agents with “detailed information” about:
This letter provides you with the information required by the DRA.
Numerous federal and State laws prohibit health care providers from submitting “false” or “fraudulent” claims to Medicare and Medicaid and other federally-funded health care programs. Presented below is a listing and description of various federal and State statutes related to the filing of false Medicare and Medicaid claims.
Federal LawsThe federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $11,803 – $23,607 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.
The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25-30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $11,803 for each claim. The agency may also recover twice the amount of the claim.
A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.The potential penalty for violating the New York False Claims Act is (1) $6,000 – $12,000 per claim, (2) payment of between two and three times the State’s damages, (3) payment of between two and three times the damages sustained by any local government, and (4) payment of the State’s legal fees.
The New York False Claims Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.The State or the local Social Services district may recover three times the amount incorrectly paid. In addition, the Department of Health may impose a civil penalty of up to $10,000 per violation. If repeat violations occur within five years, a penalty up to $30,000 per violation may be imposed if they involve more serious violations of Medicaid rules, billing for services not rendered or providing excessive services.
If an employer takes a retaliatory action against the employee, the employee may sue in State court for reinstatement to the same or equivalent position, any lost back wages and benefits and attorneys’ fees. If the employer is a health provider and the court finds that the employer’s retaliatory action was in bad faith, it may impose a civil penalty of $10,000 on the employer.
If an employer takes a retaliatory action against the employee, the employee may sue in State court for reinstatement to the same or equivalent position, any lost back wages and benefits and attorneys’ fees. If the employer is a health provider and the court finds that the employer’s retaliatory action was in bad faith, it may impose a civil penalty of $10,000 on the employer.
The federal False Claims Act imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from Medicare, Medicaid, or other federal health programs. The penalty for filing a false claim is $11,803 – $23,607 per claim and the recoverable damages are between two and three times the value of the amount falsely received. In addition, the false claims filer may have to pay the government’s legal fees.
The False Claims Act allows private individuals to file lawsuits in federal court, just as if they were federal prosecutors. If the suit eventually concludes with payments back to the government, the person who started the case can recover 25-30% of the proceeds if the government did not participate in the suit, or 15-25% if the government did participate in the suit.
This statute allows for administrative recoveries by federal agencies. If a person submits a claim that the person knows is false, or contains false information, or omits material information, then the agency receiving the claim may impose a penalty of up to $11,803 for each claim. The agency may also recover twice the amount of the claim.
A violation of this law occurs when a false claim is submitted, not when it is paid. Also, unlike the False Claims Act, the determination of whether a claim is false and the imposition of fines and penalties is made by the administrative agency, not by bringing lawsuits in the federal court system.
The Virginia Fraud Against Taxpayers Act allows private individuals to file lawsuits in State court. If the suit eventually concludes with payments back to the State, the person who started the case can recover a percentage of the proceeds based on whether the State did or did not participate in the suit.
Virginia Fraud Against Taxpayers Act, §8.01-216.3. An employee who is “discharged, demoted, suspended, threatened, harassed or in any manner discriminated against” because of the employee’s lawful acts under Virginia Fraud Against Taxpayers Act is entitled to reinstatement, double back pay with interest, special damages, and litigation costs and attorneys’ fees.
If you become aware of any compliance issues or have any questions regarding the information contained in this letter, please contact Joseph Matuza, Achieve Beyond’s Corporate Compliance Officer, at (718) 762-7633 (x 190).