Federal False Claims Act Penalties

There has been a significant financial investment by the federal government to strengthen the law enforcement agencies that are tasked with fighting fraud and waste in the Medicare and Medicaid programs.

The government has made it clear that they would rather spend funds tracking down violators than paying fraudulent claims. One of the tools in the government’s arsenal is the False Claims Act.

The False Claims Act (“FCA”) protects the federal government against any doctor or entity that submits false or fraudulent claims for payment under federal programs. And although the FCA is not new, its enforcement and penalties have increased in recent years.

Investigations and prosecutions for violations of health care fraud are among the most prevalent actions taken by the federal government under the FCA.

The FCA provides that “any person who knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” violates the act. Also, “any person who knowingly makes, uses or causes to be made a false record or statement that is material to a false or fraudulent claim” violates the act (31 USC § 3729).

In addition, any physician or other medical provider that retains money paid by the federal government that amounts to an overpayment or an error in payment can be found to have violated the FCA.