As the health care industry becomes more complex, so does compliance regarding the False Claims Act, Medicare Fraud, Medicare Abuse, Anti-Kickback Statute (AKS), Stark Law, and Criminal Health Care Fraud Statute.
Below is a brief summary as to how the Federal Civil False Claims Act (FCA) may be defined and/or interpreted.
The civil FCA, 31 United States Code (U.S.C.) Sections 3729–3733, protects the Federal Government from being overcharged or sold substandard goods or services. The civil FCA imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government.
The terms “knowing” and “knowingly” means a person has actual knowledge of the information or acts in deliberate ignorance or reckless disregard of the truth or falsity of the information related to the claim. No specific intent to defraud may be required to violate the civil FCA.
Penalties: Civil penalties for violating the civil FCA may include recovery of up to three (3) times the amount of damages sustained by the Government as a result of the false claims, plus penalties up to $22,927 (in 2019) per false claim filed.
Courtesy of CMS (2/19)