{"id":357893,"date":"2017-01-17T13:53:12","date_gmt":"2017-01-17T18:53:12","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/employment\/whistleblowers\/false-claims-act-and-healthcare-fraud.html"},"modified":"2024-03-29T08:55:51","modified_gmt":"2024-03-29T13:55:51","slug":"false-claims-act-and-healthcare-fraud","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/employment\/whistleblowers\/false-claims-act-and-healthcare-fraud.html","title":{"rendered":"False Claims Act and Health Care Fraud"},"content":{"rendered":"\n
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False Claims Act and Health Care Fraud<\/h1>\n
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\n By Olivia Wathne, J.D.<\/a> | Legally reviewed by Melissa Bender, Esq.<\/a>\n | Last reviewed\n
\n \n <\/i>\n Legally Reviewed\n <\/summary>\n\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n

Health care fraud is a serious problem in the U.S., with costs reaching an estimated $100 billion annually<\/a>. Health care fraud has become so significant that the U.S. Department of Justice has established a Health Care Fraud Unit<\/a> to address the problem.<\/p>\r\n

The False Claims Act<\/a> (FCA) is a federal law that the U.S. government uses to deal with health care fraud cases and allows private citizens to get involved. This article will discuss the federal False Claims Act, health care fraud, and where to go for help.<\/p>\r\n

What Is the False Claims Act?<\/h2>\r\n

The FCA is the big stick that the federal government uses against those who file fraudulent claims against it, especially those related to health care. False Claims Act violations can result in penalties upwards of $10,000 for each false claim. This is on top of three times the actual damages<\/a> suffered by the federal government. As a result, the act can be quite effective.<\/p>\r\n

An important aspect of the FCA is that it allows private people to sue perpetrators of fraud on behalf of the federal government. This is its qui tam provision<\/a>. People who become aware of fraudulent health care claims can sue under the FCA through a qui tam action. They may receive up to 30% of any funds recovered if successful. It’s not a bad incentive.<\/p>\r\n

Examples of Health Care Fraud<\/h2>\r\n

Health care fraud<\/a> encompasses a spectrum of deceptive practices. It often includes fraud aimed at exploiting government-funded programs like Medicaid. Kickbacks, where providers get improper payments in exchange for referrals, represent a common form of fraud within the Medicaid program, violating the anti-kickback statute.<\/p>\r\n

Another common form of fraud is upcoding. Upcoding involves billing for more expensive services than provided, while false records and deliberate ignorance of the falsity of information supplied for reimbursement further erode the system’s integrity. Such actions show a specific intent to defraud, often coupled with actual knowledge or reckless disregard for the truth, all at the expense of government funds for legitimate patient care.<\/p>\r\n

Other examples of fraud in the health care industry include:<\/p>\r\n