HR Team Member Handbook 2025

Under Section 6032 of the Deficit Reduction Act of 2005 (DRA), codified at 42 U.S.C. §1396a (a) (68), AtlantiCare Health System entities shall follow federal and state laws, pertaining to civil or criminal penalties for false claims and statements, and whistleblower protections under such laws, with respect to the role of such laws in preventing and detecting fraud, waste, and abuse in Federal health care programs. Please refer to AtlantiCare Policy 3119 – Education Concerning False Claims Liability, Anti-Retaliation Protections, and Detecting and Responding to Fraud for further guidance. Federal False Claims Act and Regulations It is also the policy of AtlantiCare Health System to obey all federal and state laws and implement and enforce procedures to detect and prevent fraud, waste, and abuse as it relates to payments to AtlantiCare Health System entities from federal and state healthcare programs, and to provide protections for those who report actual or suspected wrong doing. One of the primary purposes of false claims laws is to combat fraud and abuse in government healthcare programs. False claims laws do this by making it possible for the government to bring civil actions to recover damages and penalties when healthcare providers submit false claims. These laws often permit qui tam suits as well, which are lawsuits brought by lay people, typically employees or former employees of healthcare facilities, that submit false claims. The following information is being provided for reference purposes. Refer to actual statute for complete requirements. The False Claims Act is a federal law which imposes civil liability on organizations and individuals for knowingly submitting to the federal government as false or fraudulent and individuals for knowingly submitting to the federal government a false or fraudulent claim for payment. It applies to all federal programs, from military procurement contracts to welfare benefits to health care costs. The False Claims Act prohibits, among other things: Knowingly presenting or causing to be presented to the federal government a false or fraudulent claim for payment approval ; Knowingly making or using, or causing to be made or used, a false record or statement in order to have a false claim paid or approved by the government ; Conspiring to defraud the government by getting a false or fraudulent claim allowed or paid ; and Knowingly making or using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the government. A person or entity found liable under the Civil False Claims Act is subject to a civil money penalty of between $5,500 and $11,000 plus three times the amount of damages that the government sustained because of the illegal act. In health care cases, the amount of damages sustained is the amount paid for each false claim that is filed. A person or entity found liable under the Federal False Claims Act is subject to a civil money penalty of between $5,500 and $11,000 plus three times the amount of damages that the government sustained because of the illegal act. In health care cases, the amount of damages sustained is the amount paid for each false claim that is filed. The amount of the false claims penalty is periodically adjusted for inflation in accordance with a Federal formula. Civil False Claims Act; 31 U.S.C. Sections 3729 – 3733

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