Main Functions : False Claims Act

False Claims Act

The False Claims Act makes it illegal to knowingly submit false or fraudulent claims for payment to Medicare, Medicaid, and any other third party payer.

Claims may be false if the service:

  • is not actually rendered to the patient,
  • is provided but already covered under another claim,
  • is miscoded, or
  • is not supported by the documentation in the medical record.

For False Claims Act violations, you can be fined up to three times the program’s loss,  plus $11,000 per claim.  Fines add up quickly because each claim can be a separate ground for liability.