The federal Deficit Reduction Act of 2005 (DRA) and Louisiana's Medical Assistance Programs Integrity Law (LMAPIL) require organizations like STHS to establish written policies informing their employees, contractors and agents about the federal and state false claim acts and the role of those laws in detecting and preventing healthcare waste, fraud and abuse.
STHS has implemented required policies and procedures which are available and applicable to all employees, business partners and independent contractors who furnish healthcare items and services to our patients or on our behalf. STHS's corporate compliance plan sets the standards for conducting business with excellence, integrity and responsibility and provides guidelines that individuals may use to prevent and detect any violation of these laws. A copy of the plan is available via StTammany.health/Contractors.
As a Louisiana hospital service district, STHS also follows applicable provisions of the Louisiana Code of Governmental Ethics at LSA – RS 42:1101, et seq., and STHS’s business partners are expected to review and comply accordingly. Reference: CodeOfGovernmentalEthics.pdf (la.gov).
The False Claims Act
This federal law (31 U.S.C. §§ 3729-3733) establishes liability when any person or entity improperly receives from or avoids payment to the United States government. The Act authorizes:
- Knowingly submits a false/fraudulent claim for payment to the United States government;
- Knowingly makes/uses a false record or statement to get a false or fraudulent claim paid by the United States government or conspires with others to get a false or fraudulent claim paid; or
- Knowingly makes any false record/statement to avoid or decrease an obligation to pay the government.
Anyone who knowingly submits a false or fraudulent claim to a Medicare, Medicaid or other federal healthcare program is liable to the federal government for three times the amount of the government's damages plus penalties of $5,000 to $10,000 per false or fraudulent claim. The government may also exclude these individuals from participating in Medicare, Medicaid and other government programs, and any person or entity that makes an intentional submission of a false claim is subject to federal criminal enforcement.
Louisiana has a false claims law which is called the "Medical Assistance Programs Integrity Law" (LSA-R.S. 46:437.1, et seq.), and it is very similar to the federal False Claims Act.
Examples of False Claims
In healthcare, false claims include things such as billing twice for the same service or for services not rendered; billing for medically unnecessary services; unbundling or billing separately for services that should be billed as one; creating false medical records to increase payments; failing to report and refund overpayments; and giving or receiving unlawful inducements to healthcare providers for patient referrals.
Whistleblower Protections
Individuals who observe activities that may violate false claims laws in some way and who report their observations either to management or governmental agencies are protected under false claims laws. The protections are referred to as “whistleblower" protections. Whistleblowers may also share in a percentage of a government recovery in a false claims act action or settlement.
Reporting Suspected Healthcare Fraud and Abuse
Suspected instances of healthcare waste, fraud or abuse or other noncompliance with the laws describe in this document may be reported to STHS's Corporate Compliance Hotline at 1-866-786-3891. Callers are able to remain anonymous but must provide enough information for investigation. Reports may also be submitted to the Office of Inspector General (US Department of Health and Human Services) at 1-800-HHS-TIPS (1-800-447-8477) or the Louisiana Medicaid Fraud Control Unit at 1-888-799-6885.
Effective Date June 12, 2024 (Revised)