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FALSE STATEMENTS
- includes false statements or representation submitted to the government
- an example would be false nursing documentation
- a conviction based on a plea of no contest or guilty precludes the defendant from denying the elements of a civil lawsuit involving the false claims act
MAIL FRAUD
- this statute prohibits anyone from using the united states postal service as part of a scheme to defraud the government
- punishable by 5 years in prison and a criminal fine
- examples?
ANTI-KICKBACK PROVISIONS
- the social security act
- prohibits paying, soliciting or receiving moneys in return for medicare or medicaid referrals
RICO: TONY SOPRANO’S NIGHTMARE
- racketeer influence and corrupt organizations act
- punishment up to 20 years
- but if the violation is based on racketeering activity the punishment could be life in prison
OTHER CRIMES: IMPORTANT STATUTES RELATED TO HEALTHCARE FRAUD
- false certification
- exclusion from participaton: the death penalty
- civil monetary penalties
ELDER LAW ON HEALTHCARE FRAUD
- nursing home administrators and executives can face criminal and civil penalties
- “hang one, scare ten thousand”-sun tzu
- false claims act has been successful in fighting fraud to ensure the elderly receive the minimum standard of care
QUI TAM AND ELDER FRAUD
- Lincoln’s Law: passed in 1863 to prevent profiteers from selling shoddy or nonexistent goods to the government
- since the revisions of the act in 1986 billions of dollars have been recovered
- a defendant can be liable for treble the actual damages
- fines can reach up to $10,000.00 for each false claim submitted
FOUR MOST COMMON VIOLATIONS OF QUI TAM
- knowingly presenting to the government a false claim
- knowingly using a false record to get claim paid by the government
- conspiring with others to get a false claim paid
- knowingly using a false record to decrease the amount owed to the governmental ageny (reverse qui tam)
NURSING HOME QUI TAM VIOLATIONS
- provision of services that have not been provided but have been billed
- usually based on medical records
- conspiracy arises when outside or ancillary providers become involved
HOW DOES A PERSON PROCEED UNDER THE ACT?
- seek counsel immediately
- known as a relator
- filed under seal
- requires personal knowledge
- filed in federal court
- if government comes in the DOJ takes over
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Flores Law News 
