Podiatry Coding & Billing Alert

FCA, Stark, Anti-Kickback & HIPAA get teeth with new civil monetary penalties.

It’s safe to say that avoiding fraudulent claims has always been a best practice, but increases to civil monetary penalties (CMPs) serve to drive that point home. HHS, CMS, OIG and other governing agencies recently announced drastic hikes to CMPs for violating several major healthcare laws, including the Stark Law, the Anti-Kickback Statute, and HIPAA.

The Department of Justice’s interim final rule adjusting civil monetary penalties for inflation was published in the June 30 Federal Register. Adjustments for inflation are mandated by the Bipartisan Budget Act of 2015. The increased penalties, which the Budget Act requires to be adjusted annually, are in effect for fines assessed beginning in August 2016 and are applicable to violations occurring after November 2, 2015.

Here’s the maximum amount each violation of the laws will cost you under the new CMPs:

HIPAA: $55,010 per violation with an annual cap of $1,650,300, increased from $50,000 and an annual cap of $1,500,000.

Anti-Kickback Statute (Civil): $73,588, increased from $50,000.

Stark Law: $159,000, increased from $100,000.

False claims submitted while Stark law is being violated: $23,863 per claim, increased from $15,000 per claim.

Expect Increased Scrutiny

Healthcare law firm Arent Fox suggests in a blog post that combined with the recent Supreme Court decision in Universal Services, Inc. v. United States ex rel. Escobar, healthcare providers that rely on government funding need to be even more vigilant about valid claims submissions.

In Universal Services, the Supreme Court determined that “liability can attach when the defendant submits a claim for payment that makes specific representations about the goods or services provided, but knowingly… fails to disclose the defendant’s noncompliance with a statutory, regulatory, or contractual requirement.” The Court also went on to apply this finding to knowing omission.

The Court’s findings simplify the determination process for fraudulent claims under the False Claims Act, which Arent Fox believes will rev up federal agency scrutiny.

Now, more than ever, focus on compliance. In other words, don’t submit fraudulent claims.

For further details on the full interim final rule, visit https://www.federalregister.gov/documents/2016/09/06/2016-18680/adjustment-of-civil-monetary-penalties-for-inflation.

To read the Court’s decision, see: https://www.supremecourt.gov/opinions/15pdf/15-7_a074.pdf.