Violations of the False Claims Act

 Posted on March 11,2022 in Medical License Defense

In order to protect patients who are covered under federal health programs, such as Medicaid and Medicare, the federal government has put in place certain laws that medical providers are required to adhere to. The Department of Health & Human Services Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), and several other federal agencies are in charge of making sure these laws are followed, and to investigate and prosecute those who do not. We have discussed two of them – the Physician Self-Referral Law (Stark Law)  and the Federal Anti-Kickback Statute (AKS) – in prior posts. In this third and final post about these laws, we will discuss the False Claims Act.

The False Claims Act

Violations of the Stark Law result in civil penalties, while violations of the AKS result in criminal penalties. The False Claims Act (FCA) has both criminal and civil penalties, depending on what the government thinks the intent of the individual being charged was.

Some examples of false claims include:

• Billing for the same service more than once

• Billing for services that were never provided

• Making a false statement in order to obtain service payment

The criminal FCA makes it a federal crime to knowingly make a face claim or create a false record regarding any claims for Medicare, Medicaid, and any other federal healthcare program.

Where the criminal FCA states that an individual “knowingly” meant to defraud the government, under the civil FCA, there is no requirement of specific intent. In other words, a physician may not have intentionally set out to file false claims, but if his or her practice did, that physician is held responsible for the violation, even if they were unaware.

If a physician is found guilty of violating the FCA, they face fines of between $5,000 to $10,000, plus triple the amount of damages for each violation. They will also be excluded from any federal healthcare programs.

If the physician has been charged under the criminal FCA and is found guilty, they face significant prison time and hefty fines.

Contact an Illinois Professional License Defense Attorney

If you have been accused of committing FCA violations, or any other federal law violations, contact an Illinois FCA defense attorney immediately. These are serious charges and not only can affect your professional career and reputation but can also impact your personal life.  Call The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to schedule a free and confidential consultation.

Source:

https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/