Fraud, Waste and Abuse
False Claims Act
The False Claims Act is aimed at establishing a law enforcement partnership between federal law enforcement officials and private citizens who learn of fraud against the Government. Under the False Claims Act, those who knowingly submit, or cause another person or entity to submit, false claims for payment of government funds are liable for up to three times the government's damages plus civil monetary penalties. The False Claims Act explicitly excludes tax fraud.
The Act permits a person with knowledge of fraud against the United States Government to file a lawsuit on behalf of the Government against the person or business that committed the fraud. The lawsuit is known as a "qui tam" case, but it is more commonly referred to as a "whistleblower" case. If the lawsuit is successful, the qui tam plaintiff is rewarded with a percentage of the recovery, typically between 15 and 25%. Any person who files a qui tam lawsuit in good faith is protected by law from any threats, harassment, abuse, intimidation or coercion by his or her employer. For more information on the False Claims Act, please contact the Meridian
Corporate Compliance Officer at 1-844-667-3560 (TTY 711).
Jimmo v. Sebelius Information
On January 24, 2013, the U.S District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius. The settlement clarifies skilled care delivery for skilled nursing facilities (SNFs), home health (HH), inpatient rehabilitation (IRFs), and outpatient therapy (OPT) benefits. The Centers for Medicare and Medicaid Services (CMS) has instructed Medicare insurers like Meridian Health Plan to convey this information to our providers to ensure that services are provided and coverage determinations are adjudicated accurately and appropriately in accordance with associated policy.
For documentation requirements, revisions to relevant portions of the Medicare Benefit Policy Manual, frequently asked questions and their responses, please visit the CMS website or review the following materials below: