According the Department of Justice (DOJ), Jacksonville, Fla.-based First Coast Cardiovascular Institute (FCCI) has stumbled on a secret for nearly tripling the amount of money it owes to federal health care programs such as Medicare and TRICARE.
What is the practice's secret? Don't listen and do nothing. Based on information from the DOJ, FCCI's get-poorer-quick trick was fairly simple.
- First, the practice was warned that it had accumlated more than $175,000 in overpayments from several federal health care programs.
- Next, the practice ignored the warnings and kept the money.
- A former employee of FCCI filed a qui tam suit and the government intervened.
- Finally, the practice agreed to pay $448,821 to settle allegations that it had violated the False Claims Act.
Specifically, the government alleges that FCCI accrued credit balances or overpayments owed to federal health care programs. These credit balances often occur in a medical practice, for example, when two insurers share responsibility for a payment and one pays too much. In 2009, amendments to the False Claims Act made it a violation to knowingly fail to pay back an obligation owed to the United States and its federal health care programs. Despite repeated warnings, FCCI failed to pay back the money it owed to Medicare, Medicaid, TRICARE, and the VA until being notified that the Department of Justice had opened an investigation into their failure to repay the government.
“When FCCI learned that it had received over $175,000 in potential overpayments to federal health care programs in 2016, it had a legal obligation to return those funds within 60 days,” stated Acting U.S. Attorney Stephen Muldrow. “Instead, they delayed repayment, ultimately retaining thousands of dollars to which they were not entitled. This settlement should send a message that we will aggressively pursue those who seek to unjustly profit from our nation’s federal health care programs.”
The press release also contains a warning that it intends to enforce the 60-day overpayment rule.
“When FCCI learned that it had received over $175,000 in potential overpayments to federal health care programs in 2016, it had a legal obligation to return those funds within 60 days,” stated Acting U.S. Attorney Stephen Muldrow. “Instead, they delayed repayment, ultimately retaining thousands of dollars to which they were not entitled. This settlement should send a message that we will aggressively pursue those who seek to unjustly profit from our nation’s federal health care programs.”
That's a grim warning, but a practice that finds it owes money to federal programs should keep in mind that it may be able to enter a repayment plan that allow it to return the money in installments. But they can't wait until investigators show up to do so.