Q: Liability for fraud - under state or federal law. Question.
Unidentified person, somehow affiliated with a hospital, ordered fraudulent referral for patient to hospice upon discharge. A hospital contractor was provided medical information to document referral. I
A:
In situations where a fraudulent referral for a patient to hospice upon discharge is ordered by someone affiliated with a hospital, and a hospital contractor, without the patient's knowledge, accesses their medical information for this referral, it raises significant legal concerns under the Medicare False Claims Act.
The key issue under the False Claims Act is whether the hospital knowingly submitted, or caused the submission of, false claims to Medicare. If the hospital or its employees engaged in, or were aware of, the fraudulent activities, there could be grounds for liability. However, if the fraudulent act was solely the doing of an unidentified person without the hospital's knowledge or approval, the situation may be different.
Liability under the False Claims Act is complex and often depends on specific facts and evidence of knowledge or intent. It's crucial to conduct a thorough investigation into the circumstances of the referral and the hospital’s involvement in it. Additionally, other statutes might be relevant depending on the details of the case.
In these scenarios, seeking legal guidance to navigate the complexities of the Medicare False Claims Act and related laws is important. An attorney can help assess the case details and determine the appropriate course of action. Remember, each case is unique and should be evaluated based on its specific facts.
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