Physician Law Blog

The Affordable Care Act (PPACA) expanded the False Claims Act (FCA) to require providers to report and return any overpayment within 60 days of identification. Just what “identification” means under this rule has been unclear until now. With the SDNY’s recent ruling in Kane v. Healthfirst, Inc., No. 1:11-cv-02325-ER (SDNY Aug. 3, 2015), there is now guidance. The Kane decision, a whistleblower/false claims case, clarifies what constitutes “identification” for purposes of triggering FCA liability related to the 60 day rule to report overpayments.

False Claims Act (FCA) allegations are serious business. Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid and other federally funded programs. Omnicare learned the hard way just how serious FCA actions can be when a whistleblower made allegations against it.