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We may disclose personal information when required to do so by a subpoena, court order, or search warrant. Except when deemed by the Institute to be infeasible, the Institute will notify the individual of a subpoena, court order or search warrant for the individual’s information, by e-mail using the e-mail address (if any) that the individual provided to the Institute.
The Institute may disclose personal information as it deems appropriate to protect the safety of an individual or for an investigation related to public safety or to report an activity that appears to be in violation of law.
The Institute may disclose personal information to protect the security and reliability of this Web site and of the Institute, and to take precautions against liability.
The Institute may disclose personal information to any successor in interest (any company or organization that purchases or otherwise takes over the Hospital’s assets).
3020 Children’s Way
Mail Code 5129
San Diego, CA 92123-4282
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This Deficit Reduction Act notice applies to employees, associates, vendors, providers and any other business partner of Rady Children’s Hospital-San Diego (“RCHSD”).
The 2005 Deficit Reduction Act (DRA) established a new Medicaid Integrity Program that is very similar to the Medicare Integrity Program. The 2005 DRA funded this new Fraud and Abuse detection program with an increased level of funding up to $75 billion by 2009. This level of funding indicates the rising intensity of Medicaid scrutiny. When an organization comes under the scrutiny of the Medicaid Integrity Program, one of the items that will be reviewed is whether the organization did an adequate job of communicating the details of the False Claims Act (FCA) and the whistleblower protections throughout the organization and to agents and contractors. This notice outlines the False Claims Act and related laws and RCHSD’s role in assuring effective compliance.
As a recipient of federal health care program funds, including Medicare and Medicaid, RCHSD is required by law to include in its policies and provide to all employees, associates, agents, and contractors, detailed information regarding the federal False Claims Act and applicable state civil and criminal laws intended to prevent and detect fraud, waste, and abuse in federal health care programs.
The False Claims Act is a federal law that makes it a crime for any person or organization to make a false record or file a false claim to any federal health care program, which includes any plan or program that provides health benefits (whether directly, through insurance, or otherwise) which is funded directly, in whole or in part,by the United States Government or any State health care program. In addition the law no longer has a specific intent requirement. Receipt of an overpayment that is not refunded is also considered a false claim.
In 2009 the false claims act was amended by the Fraud Enforcement Recovery Act (FERA). In 2010 additional fraud enforcement provisions were enacted as part of the Patient Protection and Affordable Care Act (PPACA). These laws include important elements:
The False Claims Act also has provisions (called Qui Tam) that allow individuals with original information concerning fraud involving government health care programs to file a lawsuit on behalf of the government and, if the lawsuit is successful, to receive a portion of recoveries received by the government.
In most states, it is a crime to obtain something (e.g., such as a Medicaid payment or benefit) based on false information. California’s false claims act is similar to the federal false claims act allowing individuals to file a lawsuit in state court for false claims that were filed with the state for payment, such as the Med-Cal program.
There are significant penalties for violating the federal False Claims Act. Financial penalties to an organization that submits a false claim can total as much as three times the amount of the claim plus fines of $5,500-$11,000 per claim. In addition to fines and penalties, the courts can impose criminal penalties against individuals and organizations for willful violations of the False Claims Act. The false claims laws adopted in California also carry significant fines and penalties of up to $10,000 for each false claim plus triple damages.
The federal False Claims Act protects anyone who files a lawsuit under the Act from being fired, demoted, threatened, or harassed by their employer as a result of filing a False Claims Act lawsuit. Similar protections are also provided to individuals under the False Claims Act laws adopted in California.
RCHSD is committed to fully complying with all laws and regulations that apply to our organization. RCHSD has established a Compliance Program as evidence of its strong commitment to operating with the highest degree of integrity.
RCHSD’s Compliance Program includes a Code of Conduct, policies and procedures, training and education, auditing and monitoring, and mechanisms, such as our Compliance Hotline for individuals to raise issues and concerns without fear of retaliation. Information regarding RCHSD’s Compliance Program may be accessed on RCHSD’s Compliance web page.
Whether you are an employee, associate, vendor, provider, or another business partner
of RCHSD, you must:
All compliance matters will be kept confidential and your concerns will be treated with
seriousness and respect. You may also call anonymously.
RCHSD policies strictly prohibit retaliation in any form against an individual reporting an issue or concern in good faith. Retaliation is subject to discipline up to and including dismissal from employment or termination of the business relationship RCHSD.
Please contact the RCHSD Chief Compliance Officer at (858) 966-8541 if you have any questions about the above.
Additional Fraud and Abuse Laws