Face Challenges Confidently

5 Steps That Can Help You Avoid A Qui Tam Lawsuit

Tuesday, April 25th, 2017

The False Claims Act allows the government to recover losses from private entities that overcharge the government for services. The Obama Administration placed a high priority on fighting healthcare fraud, which has led to numerous investigations and large recoveries against the healthcare industry. In 2015, the administration recovered over 3.5 billion dollars.

Qui tam is a type of lawsuit brought on by a whistleblower. The whistleblower alerts the government of potential fraud or overcharges, which prompts an investigation. If the investigation is successful, the government brings a qui tam lawsuit to recover the funds and the whistleblower is entitled to a percentage of the recovery. This type of lawsuit is common in the healthcare industry.

Qui tam investigations are invasive, expensive, and carry serious penalties for any business that is found in violation of the law. Unfortunately, most healthcare practices endure qui tam investigations because some staff are lax in their intake and billing, or doctors overcharge for services. There are a few tips that your practice can implement to avoid a qui tam lawsuit or mitigate your liability in the event of a lawsuit.

Institute complete policies

The first step in preventing a qui tam lawsuit is to institute company-wide policies. Consult with an attorney to implement policies, compliance plans, and procedures that are required by federal and state law. These policies will focus on fraud, abuse, and on providing optimal patient care.

Train staff regularly

You should regularly train every member of your staff to remind them of what is required by them under the law and current policies. Ideally, staff should be trained every few months, or as necessary when laws change. Training should focus on billing practices, patient care, and any policies your practice implements.

Carefully inspect each contract

The third step in avoiding a qui tam lawsuit is evaluating every contract to ensure that it complies with both federal and local regulations. All it takes is a single lax moment to cause a qui tam investigation. Always be alert and thorough when creating and reviewing contracts.

Implement an internal whistleblowing program

Next, institute an internal whistleblowing program to avoid a qui tam lawsuit against your practice. Encourage staff and management to cooperate on reporting improper conduct or problems. You want to foster an environment that makes your staff feel safe to come forward. The best way to avoid qui tam investigations is to catch issues and correct them before they develop.

Create internal monitoring programs

Finally, institute internal monitoring programs to ensure that all policies and regulations are being complied with. To take this step, annual audits should also be considered. Once all of your employees understand the best practices for their departments, the likelihood of a qui tam lawsuit happening to you significantly decreases.

If your practice follows the above tips, you can avoid having to deal with a qui tam lawsuit. However, it is best to consult with an experienced attorney to bring your practice into compliance and prevent a qui tam lawsuit.

If you would like to learn more about keeping your practice in compliance, contact Brown & Fortunato, P.C today. We are a full service law firm that specializes in helping healthcare practices comply with federal and state regulations, among other practice areas. Call us today at (806) 345-6300 or Contact Us by email for information. You can also visit our law offices at 905 S. Fillmore, Suite 400 in Amarillo, Texas.

This information is subject to change. Please check for updates that are more recent than the published date of this article.