The False Claims Act provides that a person shall not present a fraudulent claim for government payment, conspire to do so, or receive funds in connection with a fraudulent activity. Therefore, physicians and other health providers who submit false claims to Medicare / CMS may be liable under the False Claims Act. However, providers are not liable under the False Claims Act for simply submitting a false claim to the government. Providers are only liable under the False Claims Act if they submit false claims with knowledge of the falsity. Knowledge of false information is defined as:
As of August 1, 2016, the penalty for violating the federal false claims act has increased to $ $10,781 -$21,563, plus triple the government’s damages and reimbursement of attorney’s fees and costs. The new penalty applies to claims submitted after November 2, 2015. Penalties are assessed on a per claim basis and each false claim carries its own penalty. Damages are calculated by taking the amount the provider received from the government for the false claim and multiplying that amount by three. In addition to treble damages and steep penalty fees, the government can also recover the cost of bringing the false claim action against the provider.
Violation of the false claims act is a felony, punishable up to 5 years in prison per claim. Providers can face both criminal charges and civil action for false claims act violations. Additionally, the civil monetary penalties increased to $250,00 and $500,000 if convicted of a felony false for false claims act violations.
If a provider is convicted of a False Claims Act violation, the OIG may exclude the provider from participating in federal programs. The provider may also face suspension or revocation of their medical license by the state medical board.
There are numerous ways in which a health care provider could be subject to fines, penalties, and even criminal prosecution under the Federal and State False Claims Act. Providers who are unaware of the pitfalls of the Federal and State False Claims Act statutes can find themselves inadvertently subject to large civil monetary penalties and possibly criminal prosecution. Potential violations include:
Health care providers need to be vigilant that their billing practices conform to CMS and other federal guidelines. An inadvertent error or procedural issue could lead to crippling fines and criminal penalties. Therefore, providers should seek guidance from an attorney to ensure that they are compliant with Federal and State regulations, including the False Claims Act.
Our team of attorneys are experienced I handling criminal and civil false claims act matters. We can assist you in analyzing your policies and procedures to ensure that you avoid criminal and civil liabilities for False Claims Act violations. If you find yourself under investigation for alleged false claims act violations, our attorneys will work aggressively to prevent the filing of charges, or defend you if charges have already been filed. While there may be no validity to the charges, the false claims act penalties and collateral consequences can be significant. Therefore, you need an experienced attorney that can handle all matters related to false claims allegations. Our attorneys are experienced in both civil and criminal false claims act violation, as well as state and DEA licensing, Medicare exclusions and NPDB appeals.