How The False Claims Act Affects Your Clinic

A review of the False Claims Act is beneficial even to those who have been in the healthcare industry for decades, along with those who are new to the system. The FCA was originally enacted in 1863 to address military fraud against the Union Army. And while the False Claims Act reaches beyond those in the healthcare field today, we are going to address it in specific terms for your practitioner’s office.

Understanding the False Claims Act

The False Claims Act provides that certain persons may be liable to pay a civil penalty of a minimum of $5,000 or a maximum of $10,000, plus three times the amount of damages sustained by the government. The above mentioned “certain persons” include:

1. Any person who presents, or causes to be presented, a false or fraudulent claim for approval.
2. Any person who knowingly makes or uses a record or document that will be or is used to present a false or fraudulent claim for approval.
3. Any person who conspires to get a false or fraudulent claim approved by the government.
4. Any person who knowingly makes or uses a statement to “avoid, conceal, or decrease an obligation to pay or transmit money or property to the government.”

What does this mean for a medical office?

The most obvious answer is that it takes action against Medicare and Medicaid fraud. Unlicensed or unauthorized professionals cannot submit Medicare or Medicaid claims. Nor can any unauthorized persons receive aid through these two services. All parties involved in this process will be found guilty according to the False Claims Act.

In addition, it’s beneficial to note and advise personnel that private citizens can file a suit according to the False Claims Act on behalf of the government. Even if the citizens in question were involved, they could potentially be pardoned and share in the government’s monetary recovery. This precedent was set to encourage a qui tam or whistleblower, to come forward in the crackdown against medical offices and other large organizations. The whistleblower can be an employee, competitor, or even patient. They must act as a private attorney general as well as a sort of bounty hunter.

The Justice Department has recovered more than $23 billion in False Claims Act cases since 2009, more than $15 billion of which came from cases involving health care fraud.

Don’t be caught conducting business for your medical office against the False Claims Act. If you believe that your office needs to revisit medical office management or outsource billing to be more efficient, Billing Advantage can help ease the transition and provide more stability.