Deficit Reduction Act , False Claims Act and Employee Protection

The Deficit Reduction Act and the False Claims Act combine to offer employee protection against fraud and waste and whistle blower protection, too. Compliance with these acts is key to health care program funding and keeping medical care and medical care givers both safe and sound.


First, an overview: the 2005 Deficit Reduction Act set up a new Medicaid Integrity Program quite similar to the Medicare Integrity Program. Vastly increased funding means vastly increased scrutiny of Medicare and Medicaid. This has become an increasingly vivid hot spot for government regulation, and is exactly what the False Claims Act is intended for.

When an organization is on the radar of the Medicaid Integrity Program, one area in particular that will be studied is whether the organization properly and adequately communicated all the information about the False Claims Act, and about the whistle blower protections communicating the details of the False Claims Act (FCA) and the whistle blower protections.



Concerned as to whether or not you’ve handled these details, assessed and addressed them? MedTrainer can help. Our training program is designed to ensure compliance in a wide spectrum of areas for medical, dental, and veterinary care givers. Unsure or overwhelmed about all the detailed information to be imparted? We can offer the comprehensive information coverage you need to keep your staff focused and knowledgeable - without the hassle.

After all, the False Claims Act requires knowledge to successfully implement. As a recipient of federal health care program funds, such as Medicare and Medicaid, you’re legally required to include all of its policies and provide thorough information about the federal False Claims Act to all employees and contractors. You also need to provide information about all state civil and criminal laws dedicated to the prevention and detection of fraud and waste in health care programs.

A federal law that makes it a crime for any one to make a false record or file a false claim knowingly to a federal health care program, The False Claims Act includes any plan that provides health benefits funded directly by the federal government or a state health care plan.


In short, knowing that a claim is false, or disregarding evidence that a claim may be false, is illegal: whether that false claim involves over billing Medicare for services, submitting inaccurate claims for provided services, or billing for services that were not provided. The False Claim Act deals with both patient fraud and care giver fraud and waste. Other examples include billing twice for the same service; billing for medically unnecessary services or creating false certificates indicating  medical necessity; billing for services separately that could be billed as one; creating false medical records or treatment plans designed to increase payments; failing to report and refund over payments. Other situations could include a physician billing for services rendered by medical students, interns, residents or fellows in teaching hospitals; and giving or receiving unlawful inducements for referrals for services from other health care providers.


The False Claims Act has provisions built in so that individuals with information about fraud in government health care programs can file a lawsuit on behalf of the government. These individuals can, should the lawsuit succeed, receive a portion of the recovered amount received by the government.

In most states, it is a crime to obtain a Medicaid payment or benefit by providing false information. Like the federal government, most states have laws on the books that allow individuals to file a lawsuit for false claims filed for payment.

Penalties for violating the False Claims Act are steep indeed. Financial costs can add up to as much as three times the cost of the claim made plus fines of between $5500 and $11,000 per claim. And fines and penalties aren’t the only substantial downside. Courts can impose criminal penalties too - against individuals who violated the act and against organizations who perpetrated willful or reckless violations.


Making sure your staff knows the tremendous implications of ignoring fraud or pleading ignorance to fraud and abuse is vitally important.

Along with the penalties and enforcement, the False Claim Act also offers protection - for anyone who files a lawsuit under the act. This protection serves to prevent an employee from firing, demotion, threats, and harassment incurred if the employee files a False Claims Act lawsuit.



Being fully committed to complying with health care organization laws and regulations means establishing a compliance program that clearly states your cooperation with and commitment to the legal program.

Such a compliance program includes a statement that outlines the conduct standards expected within your organization, including appropriate policies and procedures. In includes training and educating all staff members, setting up systems for auditing and monitoring, and having in place the proper channels for individuals to present any issues or concerns - without retaliation. All of these compliance materials should be easily accessible online, in employee handbooks, and handouts, and as a company policy to work with honesty and integrity.



Providing employees with information is a requirement of the Deficit Reduction Act. Signed into law in 2006 by then President Bush, the law requires states who participate in Medicaid to demand that providers who receive or make a minimum of $5 million under that state’s Medicaid program, will set up written policies for employees, contractors, and any agents to review. These written policies must give detailed information the False Claims Act, the federal Program Fraud Civil Remedies Act, whistle blower protections, and any additional or supplemental federal and state laws regarding both criminal and civil penalties for false claims and statements. Information must also be provided about the way these laws prevent and can detect waste, fraud, and abuse. And, procedures and policies must be established by the provider to prevent and detect waste, fraud, and abuse. Finally, to be in compliance with the DRA, any employee handbook
of a covered entity must include both a discussion of these laws and the rights of employees protected as whistle blowers.



Yes, there’s that word again, compliance. It is as much a part of health care and the medical profession today as the treatment of patients. Failure to comply with education requirements may cause ineligibility to receive Medicaid payments. A knowing violation of the education requirements can also result in strong penalties for submitting false claims under the False Claims Act for non-compliance.



Along with the Deficit Reduction Act, False Claims Act, medical practices of all kinds need to adhere to OSHA standards, developed to reduce hazards in the work place and successfully implement both safety and health programs. The OSHA act of 1970, like the DRA and the False Claims Act, stop an employer from discrimination against or discharging of an employee who has made a complaint, exercised a right, or participated in an investigation. HIPAA, the Health Insurance Portability and Accountability Act which  serves to establish standards of security and privacy, must also be adhered to, as does the Patient Safety and Quality Improvement act of 2005, which ensures a confidential reporting system for health care professionals to report errors and safety compromises.

In summary, from the DRA and False Claims Act to HIPAA, new laws, rules, and regulations have been established by the federal government and by state governments, to protect patients, and to prevent waste and fraud. Being in compliance with these rules and regulations, adhering to these federal laws, means educating all medical staff, and implementing written guidelines, training, and education programs. This is a lot to have on any care givers plate. MedTrainer can help you with training and education, achieve compliance, improve your efficiency, and help you to prevent the very things these laws were designed to prevent: waste, fraud, and abuse.

Waste Classifications, Regulations – Disposal and Recycling Techniques

Waste not, want not. You remember that old saying. Well, in the case of medical waste, the saying mutates to waste not poorly, if you want not to have issues in terms of waste disposal compliance.

Disposing of medical waste is a challenge for any medical, dental, or veterinary practice or hospital. If you need help in regard to understanding waste classifications and regulations, and utilizing disposal and recycling techniques adequately, MedTrainer can help. Our compliance training programs are designed to cover all aspects of medical compliance including waste handling.

Health care facilities produce a variety of waste. Many are regulated at the state and local level, others at the federal. Regulated medical waste for infectious materials are usually governed by state regulations, while the hazardous waste materials are regulated by the federal government. Just knowing the regulations and being able to respond to them successfully is difficult; finding the best ways to comply can be a “waste” of precious manpower. Knowing the regulations you must adhere to, and finding compliant disposal techniques are vitally important to the over all health of your practice as well as your staff and community.

So what about handling practices? First of all, infection risk is a major issue. Pathological waste, lab cultures, sharps - all quite dangerous in terms of the possibility of contracting an infection, and careful handling of disposal is key to prevent that possibility.

Second, there is the classification of hazardous waste disposal. Toxic materials such as chemotherapy compounds much follow additional rules based on special regulation under the Resource Conservation and Recovery Act established by the Federal government, as well as following additional state rules in many locations. In short, wastes that are regulated as both medical and hazardous can be a true challenge, as many disposal service providers who handle medical waste cannot accept hazardous items - it can be difficult to find disposal that takes both types of waste.

Most states require that all medical waste is treated before being disposed of in order to reduce risk to acceptable levels. States often have different requirements for waste types and disposal.



The main goal of any waste treatment and disposal system is to make waste noninfectious. Incineration was the first technique used to accomplish this, and while the public was kept safe from infection, generators released toxic substances into the atmosphere. EPA emission standards changed, and so did the necessity for closure of manyon-site medical waste incinerators at medical facilities. Few still operate. Now, many facilities ship waste to a centralized, monitored incineration location or use other options.
Additional waste treatment options include the use of excessive heat or contact with chemical materials designed to render them sterilized. Techniques include the use of microwaves systems, steam autoclaves, or dry heat/hot air for heat treatment. For chemical agents, the usual methods are chlorine, ozone, alkali or a combination of these treatments.


When infections materials are involved, the waste treatment must be sufficiently strong to penetrate every section of the waste. Sometimes the best way to do this, particularly when dealing with anatomical waste, is to shred or grind the materials to bring the interior to the surface. Of course there is additional cost and maintenance involved in this process, and the riks of releasing pathogens through grinding or shredding must be taken into account with careful handling on equipment which has been specially designed for the processing of medical waste.

The biggest down side to incineration is air quality issues and efficient energy usage. Many large amounts of fuel must be utilized to destroy waste, much of it used to boil water from the waste so that the organic materials will burn. This generates greenhouse gas, and is also quite costly.



Thermal treatment on the other hand utilizes high water content to advantage. Water helps to transfer and distribute heat throughout the mass of waste. Performing this treatment in a pressure chamber raises the boiling point of water sufficiently to kill most organisms. Autoclaves are particularly effective at this. In a microwave system, this type of thermal treatment subjects the waste to high intensity radio waves, efficiently delivering energy where it’s needed to sterilize. However microwave processing can be less efficient if waste is too dry.

With either autoclaves or microwaves there is no emission from disposal. On the downside, these systems are expensive. Dry heat systems are less costly, but do necessitate the use of higher temperatures and longer waste exposure time periods. As dry heat systems don’t involve combustion, unwanted reactions aren’t an issue. Air moving through the system however can carry pathogens, creating the potential for release of them.



Each of these systems require a minimum time of contact to fully destroy pathogens and process waste in a shorter time period. One method that produces the temperature desired is a plasma arc, a technique of electric discharge that creates an intense heat without combustion.

Chemical treatment is another form of waste treatment. Convenient and cost effective, they do however consume chemicals and create chemical based reactions present in the waste that can cause its own set of problems. Chlorine is a common option, working by stripping electrons out of organic compounds and oxidizing them.  Ozone and Alkaline agents are also used, and it is important to avoid exposure to ozone due to the possibility of lung damage, and to alkaline agents which can damage both skin and lungs. Risks must always be carefully weighed.

 So, once waste has been rendered safely noninfectious, it still must be disposed of. Most categories of waste can then be handled like any other solid waste. But hazardous waste cannot be - it must be disposed of in compliance with regulations.



There are also several types of regulated medical waste that require specific treatments, for those
associated with infection spread, such as pathological waste, lab cultures and sharps - such as needles and scalpel blades.

In the latter case, sharps must be disposed of in special containers and processed or encapsulated. Individual states have detailed regulatory rules. Sharps have more regulatory rules than other medical waste categories.

And what about hazardous waste materials? Many provisions and regulations apply here too, particularly in regard to the mixes of hazardous wastes, indicating that otherwise non-hazardous waste, if mixed with even a minute amount of hazardous waste, falls under restrictions applying to hazardous wastes.



These mixed wastes offer many challenges all their own, as most hazardous waste haulers cannot handle medical wastes, and is the rare medical waste disposal facility permitted to accept hazardous items.



What’s a health care practice to do? Minimizing the amount of this type of waste whenever possible is a good start, using special containers to hold the waste, and adhering to both state and federal regulations regarding containment.

Disposal and recycling techniques for medical waste depends upon type of waste, such as hazardous, or anatomical, state and federal rules and regulations, and the types of disposal techniques available to you.

The place to start is with knowledge of classifications and regulations, followed by assessing the best disposal techniques in terms of safety, efficiency, and cost.

Health comes first, and regulations focus on that, but there are intricate details of rules that may make compliance more difficult than it should be if staff is not adequately trained to recognize them. Train for health and compliance, for safety and security. That’s the bottom line regarding waste disposal and classification knowledge.