Seeking to settle an increasingly bitter dispute with healthcare providers-and perhaps stave off federal legislation that would diminish their legal powers-the U.S. Justice Department and HHS' inspector general's office on Friday issued separate and sometimes conflicting guidelines on how to enforce the federal False Claims Act as it pertains to providers.
The most significant difference is the establishment of a minimum dollar threshold to trigger the application of the act, which carries stiff financial penalties.
HHS' guidelines call for a minimum, depending on the type of billing investigation, but don't provide a universal threshold for application of the law.
The Justice Department's guidelines don't include a minimum threshold.
In a letter to Sen. Charles Grassley (R-Iowa), Deputy U.S. Attorney General Eric Holder opposed a minimum threshold because it would allow some level of fraud to go unpunished. A Grassley aide said the Justice guidelines "satisfy the concerns of the AHA (American Hospital Association)."
Grassley strongly supports the government's fraud-fighting efforts in the healthcare industry and opposes legislation backed by the AHA that would curtail the government's use of the False Claims Act against providers.
But Mary Grealy, senior Washington counsel for the AHA, was less enthusiastic.
Grealy called the guidelines a "significant first step," but she added that there were still questions to be answered. However, the AHA has not backed off of its support for legislation.
The guidelines are a clear political victory for healthcare providers, which have accused the government of using heavy-handed tactics to extract Medicare and Medicaid false-billing settlements from hospitals and physicians for what they say are innocent billing errors.
HHS' guidelines were disclosed in a letter sent last week by HHS Inspector General June Gibbs Brown to Rep. Ron Klink (D-Pa.). Klink had called on HHS to work with providers to develop some enforcement guidelines. Shortly thereafter, the Justice Department provided its guidelines to Grassley, who released them to the public. Grassley has staunchly opposed AHA efforts to modify the act.