False claims and whistleblower laws

The Evangelical Lutheran Good Samaritan is committed to compliance with all laws and regulation, including those governing healthcare program claims and payment requirements. In keeping with that commitment, the Society has implemented a Corporate Compliance Program that is designed, inter-alia, to detect and prevent improper payments for services.

Governments at both the federal and state levels have passed laws whose aim is to deter fraud, waste and abuse of public health programs. Many of these laws have “whistleblower” provisions that prevent retaliation against employees who make good faith reports of suspected illegal activities. Some also have provisions that can, under certain circumstances, provide for the sharing of monetary recoveries the government may obtain based on information the government obtains from reporters.

Listed below are the Society's summaries of these laws as well as information about tools available to employees, contractors and agents to help all of us do our part to support the Society’s strong commitment to preventing health program fraud, waste and abuse. Please access the links below and carefully consider your role and responsibility in ensuring the Society only bills and receives payment for services that are necessary and properly delivered and documented.

(These summaries are not intended as legal advice. They are intended for informational purposes only and no express or implied warranties are made regarding the timeliness or accuracy of the information.*)

Federal False Claims Act

The federal False Claims Act permits a person with knowledge of fraud against the United States Government, referred to as the "qui tam plaintiff," to file a lawsuit on behalf of the Government against the person or business that committed the fraud (the defendant). If the action is successful the qui tam plaintiff is rewarded with a percentage of the recovery. Click here for the FCA primer.