1.16 – False Claims Act

Open Door takes health care fraud and abuse very seriously. Open Door is committed to following all applicable laws and regulations, in particular, those that address health care fraud, waste, and abuse and proper billing of Medicare, Medicaid, and other government funded programs. This includes the Federal False Claims Act and State and Local Law.

The Federal False Claims Act allows a civil action to be brought against a health care provider who:

• Knowingly present or causes to be presented, a false or fraudulent claim for payment or approval to any federal employee;
• Knowingly makes, uses or causes to be made or used a false record or statement to get a false fraudulent claim; OR
• Conspires to defraud the government by getting a false or fraudulent claim allowed or paid.

This includes: billing for procedures not performed, falsifying information in the claims record, billing unnecessary services, non-covered services, of for incorrect level of service.

Open Door prohibits discrimination against any employee in the terms or conditions of his or her employment because the employee initiated or otherwise assisted to identify, report, or participate in an action related to False Claims Act. The Open Door policy for Corporate Compliance further outlines all reporting procedures for waste, fraud, abuse, and other allegations.  (refer to 1.14)

Last Revised: 1/31/22