The Attorney General works to protect the state against fraud and other financial misconduct through the enforcement of the California False Claims Act.
False Claims Act [31 U.S.C. It is illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent. Filing false claims may result in fines of up to three times the programs' loss plus $11,000 per claim filed.
Healthcare fraud, government contractor fraud, and environmental fraud are common types of False Claim Act cases. The False Claims Act allows individuals to report companies, federally funded programs, or individuals who commit fraud against the U.S. Government.
As the name implies, the False Claims Act in the healthcare sector prohibits workers from submitting fraudulent claims. In other words, healthcare practices must not bill the government for things they did not do. As a healthcare practice, you can typically submit claims to Medicare or Medicaid.
The False Claims Act, 31 U.S.C. §§ 3729, provides that anyone who violates the law “is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, . . . plus 3 times the amount of damages.” But how does that apply in practice?
The False Claims Act proscribes: (1) presenting a false claim; (2) making or using a false record or statement material to a false claim; (3) possessing property or money of the U.S. and delivering less than all of it; (4) delivering a certified receipt with intent to defraud the U.S.; (5) buying public property from a ...
About 80 percent of all fraud cases won under the False Claims Act are a direct result of whistleblower lawsuits. Whistleblower awards under the Federal law have averaged 17% of recoveries.
Examples include people who lie to Medicare or Medicaid, facilities that bill for services they did not provide, or those that inflate the cost of the services they did get. They may even lie about who is providing services. The company bills the government for skilled professionals but uses non-professionals instead.
Examples of false claims include billing for services not provided, billing for the same service more than once or making false statements to obtain payment for services. Violations under the federal False Claims Act can result in significant fines and penalties.
Filing claims with incorrect codes can create explicit liability under the federal and state False Claims Acts. Such a situation means that service providers become liable for triple damages and civil claims for each such submission.
A lawsuit under the False Claims Act can threaten the very survival of a medical practice. Violations of this statute result in liability for treble damages and potentially ruinous civil penalties. It is a law with which every medical practitioner and practice manager should be familiar.
This important provision allows any individual or non-governmental organization to file a lawsuit, in U.S. District Courts, on behalf of the United States government. Under this provision, whistleblowers can be rewarded for confidentially disclosing fraud that results in a financial loss to the federal government.