July 23, 2015

False Claims, Meaningful Use, and HIPAA Compliance: What's the Connection?

Travis Good, MD

Co-founder & Chief Technology Officer

First, what is the False Claims Act?

The False Claims Act inflicts forfeitures on anyone and everyone who knowingly forges, alters, falsifies, or demolishes documents to protected payment.

The repercussions for each civil penalty if found in violation are:

  • Each claim of no fewer than $5,500 and no more than $11,000
  • Triple the amount of treble damages that the federal government sustains.

Meaningful Use

Second, what is Meaningful Use?

This is the terminology that the federal government uses as a way of describing the utilization and compliance of Electronic Health Record technology in a fashion to accomplish specific requirements:

  • Enhance quality, safety, and efficiency, while minimizing health disparities
  • Encourage patient and family engagement
  • Improve coordination of care and public/population health
  • Sustain security and privacy of PHI

What do False Claims Act and Meaningful Use have to do with HIPAA compliance?

Among the requirements mandated by Meaningful Use to receive incentive payments is to conduct a data security risk assessment. On a similar note, one of HIPAA’s core requirements is for entities to conduct the same assessment. In layman’ terms, compliance with one should satisfy the requirements by the other. Should be simple, right?


Pre-audit screenings have begun for the next round of audits to be conducted randomly. If an audit determines that there is a possibility that an entity has not performed a risk assessment, the findings could be shared with the Centers for Medicare and Medicaid Services. This would trigger repayment of Meaningful Use and False Claims Act repercussions and possible jail time. And to add fuel to the fire, an investigation would be opened and conducted that could result in further fines and settlements.

So what do you do?

This part is simple. Conduct a risk assessment. Not performing one has the potential of costing millions, prison time, reputation loss, and exclusion from Medicaid and Medicare.

Learn all you need to learn about HIPAA from our free compliance guide to become a compliance expert in a single coffee break.

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