Healthcare Companies Need to Update Compliance

The Supreme Court’s decision upholding most of the Affordable Care Act increased compliance responsibilities for healthcare companies.  The ACA amended the False Claims Act (FCA), which was amended in 2009 in the Fraud Enforcement and Recovery Act. The FCA amendments in 2009 and 2010 have had a dramatic impact on businesses. 

The 2009 amendments expanded the definition of “claim” and the definition of “obligation” to impose potential liability for the retention of overpayments or for regulatory violations that negatively affect a government program or interest.   The ACA’s antifraud provisions added a new definition of “obligation,” requiring repayment of an identified overpayments within 60 days to avoid the presumption of FCA liability. The ACA also provided, as a matter of law, that a violation of the Anti-Kickback law is a violation of the FCA.   In addition, the ACA included new transparency requirements which are designed to identify relationships that may pose a conflict of interest.