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NOTE: THE FOLLOWING IS ONLY
A SUMMARY

For more detailed information, we recommend searching the internet using keywords “false claims” “whistleblower” and “qui tam”. We recommend in particular the websites maintained by the Centers for Medicare & Medicaid Services (www.cms.hhs.gov) and the U.S. Department of Health & Human Services Office of Inspector General (oig.hhs.gov). If you wish to assert your rights under any of these laws, you are advised to seek the assistance of a licensed attorney.

FEDERAL FALSE CLAIMS ACT:

The Federal False Claims Act is codified as 31 USC §§3729 – 3733. It provides that anyone who files a false or fraudulent claim to the federal government for payment or approval (for example, a false or fraudulent claim for Medicare reimbursement) is subject to a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages that the federal government sustains because of the act. The person filing the claim need not know the claim is false to be liable. Liability will attach where the person acts in deliberate ignorance of the truth or falsity of the information or acts in reckless disregard of the truth or falsity. No specific intent to defraud is required.

The Federal False Claims Act contains a provision for “Qui Tam plaintiffs”. [31 USC §3730(b)] A private individual may bring a civil action for a false claim on behalf of the federal government. If the federal government proceeds with the action, it will assume responsibility for the case, but the private individual will remain a party. If the federal government declines to proceed, the private individual may proceed alone.

If the federal government proceeds with the action, the private individual may receive at least 15 percent but not more than 25 percent of the proceeds of the action “depending upon the extent to which the person substantially contributed to the prosecution of the action”. [31 USC §3730(d)] The Qui Tam plaintiff may also recover any attorney fees and costs incurred.

An administrative version of the Federal False Claims Act known as the Program Fraud Civil Remedies Act ("PFCRA") is codified as 31 USC §§ 3801-3812. It provides for penalties of not more than $5,000 and 2 times the amount of damages for filing false claims to any of various federal agencies.

STATE FALSE CLAIMS ACT:

The State of Indiana has its own False Claims Act codified as IC 5-11-5.5. For filing a false claim against the State of Indiana, you can be liable for at least $5,000 and up to 3 times amount of damages to the state. As with the federal version, a civil action may be brought by a private individual as a Qui Tam plaintiff under IC 5-11-5.5-4. The Qui Tam plaintiff may receive between 15 and 25 percent of the proceeds of the action as well as attorney’s fees and costs.

FEDERAL WHISTLEBLOWER PROTECTION:

Federal law provides that “[a]ny employee who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment by his or her employer because of lawful acts done by the employee on behalf of the employee or others in furtherance of an action under [the Federal False Claims Act], including investigation for, initiation of, testimony for, or assistance in an action filed or to be filed under [the Federal False Claims Act] shall be entitled to all relief necessary to make the employee whole. Such relief shall include reinstatement with the same seniority status such employee would have had but for the discrimination, 2 times the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorney’s fees. An employee may bring an action in the appropriate district court of the United States for the relief provided in this subsection.” [31 USC §3730(h)]

STATE WHISTLEBLOWER PROTECTION:

Indiana law provides that “[a]n employee who has been discharged, demoted, suspended, threatened, harassed, or otherwise discriminated against in the terms and conditions of employment by the employee’s employer because the employee: (1) objected to an act or omission described in [IC 5-11-5.5-2]; or (2) initiated, testified, assisted, or participated in an investigation, an action, or a hearing under this chapter; is entitled to all relief necessary to make the employee whole. Relief under this section may include: (1) reinstatement with the same seniority status the employee would have had but for the act described [above]; (2) two (2) times the amount of back pay owed the employee; (3) interest on the back pay owed the employee; and (4) compensation for any special damages sustained as a result of the act described [above] including costs and expenses of litigation and reasonable attorney’s fees. An employee may bring an action for the relief provided in this section in any court with jurisdiction.” [IC 5-11-5.5-8]

REPORTING FRAUD, WASTE, AND ABUSE TO
AGENCIES OUTSIDE THE HOSPITAL:

In the event that you believe Scott Memorial Hospital is engaged in fraud, waste, or abuse and you wish to report that activity to an outside agency, the following toll-free numbers are available:

· If you want to report fraud, waste, or abuse in the Indiana Health Coverage Program (IHCP) or Medicaid, you may call 1-800-457-4515 to make a report. This number connects you with the Health Care Excel Provider and Recipient Concern Line. You may remain anonymous if you wish.

· To file a complaint about the hospital with the Indiana State Department of Health, you may call 1-800-246-8909.

· If you want to report fraud, waste, or abuse in the Medicare or Medicaid programs, you may call 1-800-HHS-TIPS. You may remain anonymous if you wish.