False Claims Prevention Policy

The entire Pure Healthcare organization is committed to preventing fraud, waste, and abuse in the health care industry. As an organization that receives federal funding, it is our responsibility to abide by all federal and state laws to effectively implement and enforce procedures to prevent and detect any violations through education and training of our employees and compliance management. All workforce members, contractors, and agents will be responsible for reporting potential or suspected violations of fraud and abuse directly to their supervisor or the organization’s compliance officer.  

The False Claims Act

The False Claims Act (FCA) is a federal law that prohibits any submission of false information, records, or claims by any person or organization to a federal health care program. This includes any plan or program that provides health benefits, whether directly or through insurance and otherwise, that are funded in whole or in part by the United States Government or any state healthcare system. Examples of false claims can include billing for services not rendered or deemed medically necessary, billing for the same service more than once, or falsifying documentation to receive payment for services. Violations can occur either by actively knowing about a false claim or through acts of negligence and disregard to whether a claim is false. 

Civil Penalties for Violations

The False Claims Act states that any person who knowingly submits false claims to the government is liable for a civil mandatory penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages (called treble damages), which the Government sustains because of the act of that person. The FCA has been amended several times and now includes the provision that violators are liable for treble damages plus a penalty that is linked to inflation (The United States Dept of Justice, January 14th, 2021).

In addition to allowing the United States government to pursue perpetrators of fraud on its own, the FCA allows private citizens the right to file suits on behalf of the government (called qui tam suits) against those who have defrauded the government. By doing so, these private citizens who successfully bring qui tam actions may receive a portion of the government’s recovery.

Whistleblower Protection Under the False Claims Act

The federal FCA law also protects employees who report a violation under the False Claims Act from discrimination, harassment, suspension, or termination of employment as a result of reporting possible fraud within an organization. Employees who report fraud and consequently suffer discrimination may be awarded two-times their back pay plus interest, reinstatement of their position without loss of seniority, and compensation for any costs or damages they incurred.

Regulations Cited 

The Federal Civil False Claims Act, Section 3279 through 3733 of title 31 of the United States Code.

Pure Healthcare Compliance Department
4179 S Riverboat Road, Suite 203
Taylorsville UT  84123

Compliance Hotline
Phone:(801) 823-0120
Email: compliance@montanaarthritis.com