False Claims Act Essay

476 Words2 Pages
1. What are the five elements pertaining to establishment of a false claim under the False Claims Act? To prove that a healthcare provider has submitted a false claim knowingly, the government must establish that the person submitted the claim with actual knowledge, in deliberate ignorance, or with reckless disregard for the claim’s truth or falsity. The FCA is not intended to apply to honest mistakes and negligence. Yet, those doing business with the government are obligated to make at least limited inquiries as to the accuracy of the claims they submit. 2. HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each. Define and limit the circumstances in which entities use and discloses PHI, Require covered entities to adopt…show more content…
Discuss the following a. Qui tam is known as whistleblower suits. In qui tam action a relator with personal knowledge of a fraud brings the suit against a defendant of behalf of the government. The knowledge with which the relator brings a qui tam action must be public knowledge but information that would not otherwise be available without the qui tam suit. b. HIPAA Privacy rule is the Health Insurance Portability and Accountability Act of 1996. HIPAA was enacted to improve the Medicare and Medicaid programs and the efficiency and effectiveness of the healthcare system by encouraging the development of a health information system through the establishment of standards and requirements for the electronics transmission of certain health information. The privacy rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. c. EMTALA is the Emergency Medical Transfer and Active Labor Act that requires all Medicare or Medicaid participating hospitals with an emergency department to provide medical screening to each patient requesting emergency care to determine whether the patient requires such
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