32 Miss. Code. R. 1.18

Current through December 10, 2024

Section 32-1.18 - THE FALSE CLAIMS ACT (DEFICIT REDUCTION ACT OF 2005)

The Department of Rehabilitation Services has a strong and continuing commitment to ensure that its services are conducted in accordance with applicable laws relating to all professional practices, third party reimbursement, and contractual and legal obligations. Knowledge of applicable laws that could affect the Department is essential for employees. One such law is the False Claims Act.

The False Claims Act is aimed at the following conduct:

(1) knowingly presenting or causing to be presented a false or fraudulent claim for payment to the government;

(2) knowingly using a false record or statement to obtain payment on a false or fraudulent claim paid by the government; or

(3) engaging in a conspiracy to defraud the government by getting a false or fraudulent claim allowed or paid.

For purposes of the False Claims Act, the terms "knowing" and "knowingly" mean that a person, with respect to information:

(1) has actual knowledge of the information;

(2) acts in deliberate ignorance of the truth or falsity of the information; or

(3) acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.

Under the False Claims Act, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for three times the government's damages plus civil penalties of $5,000 to $10,000 per false claim.

Examples of fraud include, but are not limited to:

* billing for services not rendered;

* requesting, offering, or receiving a kickback, bribe, or rebate;

* using an incorrect or inappropriate provider number in order to be paid;

* selling or sharing patients' Medicare/Medicaid numbers so false claims can be filed;

* falsifying information on applications, medical records, billing statements, and/or cost reports or on any statement filed with the government;

* submitting time and task (services) which were not provided;

* filing a false timelog/authorization/claim;

* submitting false invoice;

* billing for equipment/supplies never ordered;

* billing Medicaid/Medicare for new equipment but providing the client used equipment;

* billing Medicaid/Medicare for expensive equipment but providing the client cheap equipment; and

* charging more than once for the same service.

For more detailed language of the Statute see Appendix 1.

Furthermore, to encourage citizens to report violations, certain protections are in place to shield an individual from retaliation for bringing suit against his or her employer. Any such individual is protected under the "whistleblower" section of the False Claims Act.

32 Miss. Code. R. 1.18