Problem:
Using 100 words or more and APA format to respond to the following:
Name the federal law enforcement agencies that share responsibility for prosecuting health care fraud and abuse and explain their role.
What is the False Claims Act, and how does it apply to the health-care setting? Agree or disagree? Explain. Need Assignment Help?
There are many federal law enforcement agencies that share responsibilities for prosecuting health care fraud and abuse. Some of these agencies include the Department of Justice, Department of Health and Human Services, Federal Bureau of Investigation, Centers for Medicare and Medicaid Services, and the State Medicaid Fraud Control Units. These agencies will work independently or jointly to investigate, prosecute, and penalize healthcare fraud.
Department of Justice has ultimate authority over federal criminal and civil litigations; the DOJ prosecutes civil and criminal healthcare fraud cases, files the lawsuits, negotiates settlements, and enforces penalties.
The Department of Health and Human Services is the administrative enforcement and investigation authority for Health and Human Services programs and conducts administrative and criminal investigations into billing fraud, kickbacks, and the quality of care issues.
The Federal Bureau of Investigation is the lead investigative agency for both public and private healthcare fraud.
The Centers for Medicare and Medicaid Services is the administrative oversight and fraud prevention for Medicare and Medicaid.
The State Medicaid Fraud Control Units investigate and prosecutes Medicaid fraud and patient abuse.
The False Claims Act is the civil statue which combats fraud, waste, and abuse. The act imposes civil liability on those who knowingly submit or cause to be submitted a false or fraudulent claim for the federal government to pay. The False Claims Act applies to the healthcare setting whenever a provider, facility, or billing company submits claims to federally funded healthcare programs.