The False Claims Act carries treble damages and per claim penalties, and it's enforced in part through qui tam suits, meaning a whistleblower, often an employee, can bring a case on the government's behalf and share in the recovery. That last detail is why this law reaches further into a practice than most physicians assume. It isn't only a government auditor who can trigger a case.
What actually counts as a false claim in practice is broader than deliberate fraud. Billing for a service that wasn't documented as delivered, upcoding a visit level that the note doesn't support, or submitting a claim that violates Stark or Anti-Kickback (both of which can trigger False Claims Act liability on their own) all fall under this law, whether or not there was intent to defraud anyone.
Written by John M. Abrahams, MD — board-certified neurosurgeon, founder of New York Brain & Spine Surgery.
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