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Physicians & health care fraud: 3 FAQs about the False Claims Act

There are certain federal laws that impact a physician no matter where they practice medicine. One example is the False Claims Act (FCA). This law essentially makes it illegal to submit claims for payment from Medicare or Medicaid that the physician knows or should have known was a false or fraudulent claim.

What are the potential penalties?

One of reasons physicians should be aware of this law is the fact that a violation comes with harsh penalties. According to the Offices of Inspector General for the United States Department of Health and Human Services (HHS), penalties can include a fine of up to three times the program's loss and an additional $11,000 per claim.

The claim needs to be intentional, right?

Not always. The civil FCA allows a successful claim if the physician acted with "reckless disregard of the truth or falsity of the information" when filing the claim.

It is also important to note the government can pursue claims for civil or criminal FCA violations. If a criminal claim is successful, a conviction could come with monetary penalties as well as potential imprisonment.

Unfortunately, imprisonment is not uncommon. The government just built a successful case against an ambulance company for making false claims when it provided medically unnecessary transportation services. The court sentenced the operator of the company to 30 months imprisonment.

What if I am accused of an FCA violation?

The process generally begins with a federal investigation. Those who receive notification of such an investigation are wise to act to protect their interests. An attorney experienced in Medicare Fraud cases can review the allegations and discuss your options.

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