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Compliance with Fraud Laws
Attached is the Saint Vincent Catholic Medical Centers ("the Hospital") policy on compliance with fraud laws. The Hospital is committed to preventing fraud, waste and abuse in federal and state healthcare programs, and has policies and procedures to ensure compliance.
In summary, some of the laws and regulations referred to in the policy are:
Federal and NY State False Claims Act - both laws make it illegal to make false statements or claims in an attempt to get payment from governmental agencies, such as Medicare and Medicaid.
Program Fraud Civil Remedies Act is a federal law that prohibits submission of false or fraudulent information on a written statement when the person or entity knows or has reason to know that the information is false.
The False Statements section of the Social Services law makes it a violation to obtain or attempt to obtain payment from a Social Services program, such as Medicaid, by using a false statement, concealing information, or any fraudulent scheme.
The Social Services Law section regarding "Sanctions" is a criminal law that penalizes a person who applies for public assistance by making a false or misleading statement.
Penalties for violation of these laws range from misdemeanors to felonies depending on amount of money involved, number of times the law was violated, and a variety of other determining factors.
The Federal False Claims Acts includes a Whistleblower Protection provision that prohibits employers from retaliating against employees who report a potential violation. Employees can disclose information about the employer's policies to a public official without fear of reprisal. Employees are only protected when the employee first brings up the matter to a supervisor and the employer is given a reasonable opportunity to correct the alleged violation.
The full details of these regulations and more information are attached in the policy. If you have any concerns or questions regarding these laws, please feel free to contact the director of compliance at (212) 356-4538, or the Saint Vincent's Compliance Hot Line at 1-800-348-9528.
Please click here to download the policy.
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