Venture Together is subject to all federal and state laws regarding fraud, waste, and abuse in government-funded/regulated programs. The False Claims Act is one of the laws the government uses to prevent and detect fraud, waste and abuse in federal health care programs. It prohibits anyone from “knowingly” submitting false claims to the government. The False Claims Act defines “knowingly” to mean that a person:

  1. has actual knowledge of the false claim;
  2. acts in deliberate ignorance of the truth or falsity of the information; or
  3. acts in reckless disregard of the truth or falsity of the information.

Specifically, the False Claims Act may be violated by the following acts:

  • Knowingly presenting, or causing to be presented, a false or fraudulent claim for payment or approval by the Federal Government;
  • Knowingly making or using, or causing to be made or used, a false record or statement to get a false claim paid or approved;
  • Conspiring to defraud the Government by getting a false or fraudulent claim allowed or paid; or
  • Knowingly making, using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay money or transmit property to the Government.

Examples of Medicaid Fraud:

  • Billing for program services that were not actually provided.
  • Providing unnecessary services in order to bill them.
  • Billing for more expensive services.
  • Billing for services separately that should be one billing.
  • Billing more than once for the same service (double billing).
  • Giving or accepting something of value (cash, gifts, services) in return for medical services, i. e., kickbacks.
  • Falsifying cost reports.
  • Lying about their eligibility
  • Lying about their medical condition
  • Forging prescriptions, and
  • Loaning their Medicaid card to others.

Or, when a health care provider falsely charges for:

  • Missed appointments
  • Unnecessary medical tests
  • Telephoned services.

Venture Together has an open door policy and welcomes compliance related questions, concerns, suggestions and/or complaints. Individuals may direct these to their supervisors, or may make a confidential report directly to the Compliance Officer, or anonymously through the Compliance Hotline. The Compliance Hotline telephone number is (845) 624-4039.

The Compliance Officer is responsible for ensuring that all complaints about unethical or illegal conduct are investigated and resolved. Anyone filing a written complaint concerning a violation or suspected violation must be acting in good faith and have reasonable grounds for believing the information disclosed indicates a violation. Venture Together is prohibited from taking any adverse actions against persons who notify the government of actual or potential violations. Venture Together will not impose any disciplinary action in retaliation against individuals who make a report or complaint in good faith to the government, their supervisor, or to the Compliance Officer regarding a practice that the individual believes may violate Venture Together’s Corporate Compliance Plan, Code of Conduct, the False Claims Act or any of the laws, rules or regulations by which Venture Together is governed. For more detailed information regarding the agency’s polices with regard to reporting compliance concerns, anti-retaliation and/or the False Claims Act, you can contact the Compliance Officer: Alice Kayser (845) 624-5407 email: Office of the Medicaid Inspector General 1-877-87-FRAUD (1-877-873-7283)

Privacy Breaches may be reported to the Privacy Officer, Alice Kayser at (845) 624-5407.

Examples of Privacy breaches:

  • Sending protected health information to the wrong person or wrong address
  • Sending PHI without an appropriate consent in the file
  • Sending unencrypted PHI over Agency’s email system
  • Sending PHI via text message.