When a Violation of a Rule or Regulation Becomes an FCA Violation: Understand... the Distinction ...

(Source: Akin Gump Strauss Hauer & Feld LLP) This question is particularly pressing for those participating in Medicare and Medicaid programs. Prior to participation in these programs, health care providers and suppliers must enter into various agreements certifying that they will adhere to various rules and regulations. When submitting claims for payment or cost reports, health care entities must also certify that they complied with various federal and state rules and regulations. However, some of the rules and regulations to which they certify compliance are trivial in nature and would not, and should not, result in the denial of payment on a claim if the service is covered and otherwise...