Federal False Claims Act Case Study

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Under the Federal False Claims Act and the Criminal False Claims Act, an employee could be held responsible for committing a crime if they file a false claim for the physician. (Fordney, 2010) The definition for fraud states “No proof of specific intent to defraud is required for fraud to be considered”. (Fordney, 2010) In Ohio, my resident state, there were several places on-line in which someone could file a Whistleblower report. (OhioBWC - Common - Form: (Reporting fraud) - Introduction) (Ohio Attorney General Mike DeWine - Health Care Fraud FAQs) Only being employed for eight months and already seeing signs of false claims, would not make my decision to report this physician very difficult. I would document in writing to the provider the false claim followed with a written memo to both the physician and office manager. At this point I would also file a Qui Tam report to protect myself. (Fraud covered by the False Claims Act) I would say to protect my job but considering this is a small office, I feel I would need to leave regardless of the outcome. I would not know if this was something…show more content…
T. (2010). Insurance Handbook for the Medical Office. Maryland Heights, Missouri: Saunders. Fraud covered by the False Claims Act. (n.d.). Retrieved from False Claims Act attorney, Tycko & Zavareei LLP, False Claims Fraud | Tycko & Zavareei LLP: http://www.fraudfighters.net/false-claims-act-fraud/ Insurance-Fraud-Handbook.pdf (application/pdf Object). (n.d.). Retrieved from http://www.acfe.com/uploadedFiles/ACFE_Website/Content/documents/Insurance-Fraud-Handbook.pdf Ohio Attorney General Mike DeWine - Health Care Fraud FAQs. (n.d.). Retrieved from http://www.ohioattorneygeneral.gov/FAQ/Health-care-fraud-FAQs#FAQ342 OhioBWC - Basics: Fraud Red Flags. (n.d.). Retrieved from Ohio.gov: http://www.ohiobwc.com/Default.aspx OhioBWC - Common - Form: (Reporting fraud) - Introduction. (n.d.). Retrieved from

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