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Mt. Washington Pediatric Hospital (the "Hospital"), is required by federal law to provide information to all of its employees, contractors and, agents regarding the federal false claims act, administrative remedies for false claims and statements, the state false claims act and whistleblower protections under these laws. The federal and state false claims acts play an important role in detecting fraud, waste and abuse in federal health care programs.
Federal False Claims Act
What the law does:
It allows a civil action to be brought against a health care provider that:
Examples of a false claim:
Federal Whistleblower Protections
Federal law prohibits an employer from retaliating against an employee, contractor or agent in the terms or conditions of employment because the employee, contractor or agent initiated or otherwise assisted in a false claims action. The employee, contractor or agent is entitled to all relief necessary to make the employee, contractor or agent whole.
Maryland False Claims Provisions
Maryland, like many other states, has enacted a statute similar to the federal False Claims Act that provides for criminal and civil remedies for the submission of false and fraudulent claims to the Medicaid program. Under Maryland’s Medicaid fraud statute, it is a crime for a person to knowingly and willfully:
Examples of false representations include:
Maryland Whistleblower Protections
Maryland law prohibits retaliatory action by an employer against an employee who in good faith reports:
Any potential violation of state or federal law by an employer as a health care provider; or
Any situation where an employer provides care in a manner that violates state or federal standards or laws or recognized clinical or ethical standards.
Monitoring Mt. Washington Pediatric Hospital’s Policies & Procedures for Detecting Fraud & Abuse
The Hospital has established internal systems and controls to monitor its coding and billing practices on an ongoing basis to ensure compliance with the False Claims Act and similar state laws.
In addition, an external independent auditor performs an annual audit of the Hospital’s patient financial services operations. The auditors test the accuracy of the Hospital’s reporting and checks to make sure the appropriate checks and balances are adhered to in each phase of the department's operations.
What you should do if you think the Hospital may have made a false claim?
If you as an employee or a contractor/agent see something that looks like one of the examples of a false claim provided above, the Hospital encourages you to:
You are not required to report a possible false claims act violation to the Hospital first. You may report directly to the federal Department of Justice.
If you have any questions about this information, please call the Hospital’s Compliance Department at 410 328-3848.
You can find additional information about the False Claims Act at:
1 This information is being provided in compliance with the federal Deficit Reduction Act of 2005.