Switch to ADA Accessible Theme
Close Menu

Understanding the Implications of False Claims Act Violations for Healthcare Providers

Surgery bills with health insurance claim calculator and pen

The healthcare industry is heavily regulated, with numerous laws and regulations in place to ensure that patients receive quality care and that government funds are used appropriately. One of the most significant pieces of legislation in this context is the False Claims Act (FCA), which has far-reaching implications for healthcare providers. Without a proper defense, False Claims Act cases can cost you tens of thousands of dollars in fines and lead to the loss of a medical license, exclusion from Medicaid, and other penalties. In this blog post, we will explore what the False Claims Act is, how it affects healthcare providers, and what steps can be taken to avoid violations. If you are being confronted with a False Claims Act lawsuit, contact the Law Offices of Art Kalantar for immediate assistance from a skilled and experienced California healthcare law attorney.

What Is the False Claims Act?

The False Claims Act is a federal law that imposes liability on individuals and companies (typically federal contractors) who defraud governmental programs. The Act is designed to protect the government from being overcharged or sold substandard goods or services. It is particularly relevant in the healthcare sector, where providers bill government health programs such as Medicare and Medicaid for services rendered to patients.

How Does the False Claims Act Affect Healthcare Providers?

Healthcare providers, including doctors, pharmacists, and hospitals, can be held liable under the False Claims Act for a variety of actions, such as:

  1. Overbilling: Charging for more services than were actually provided or billing for services that were not medically necessary.

  2. Upcoding: Billing for a more expensive service than the one actually performed.

  3. Kickbacks: Receiving or offering remuneration in exchange for referrals or for prescribing certain medications or treatments.

  4. Unbundling: Billing separately for services that should be billed together at a reduced rate.

Violations of the False Claims Act can result in significant financial penalties, including treble damages (three times the amount of the government’s loss) and fines of over $11,000 per false claim. Additionally, healthcare providers found in violation of the Act can face exclusion from participating in federal healthcare programs, which can be a death knell for a provider’s practice.

Avoiding False Claims Act Violations

To avoid the severe consequences of False Claims Act violations, healthcare providers should implement the following best practices:

  1. Implement Compliance Programs: Establishing a robust compliance program can help identify and prevent potential FCA violations. This program should include regular training for staff, routine audits, and clear policies and procedures.

  2. Maintain Accurate Records: Keeping detailed and accurate records of services provided and billing practices is crucial. These records can serve as evidence of compliance in case of an audit or investigation.

  3. Seek Legal Advice: Consulting with a healthcare law attorney can provide guidance on compliance with the False Claims Act and other relevant regulations to prevent problems from arising in the first place. Legal counsel can also assist in responding to any allegations or investigations.

  4. Promptly Address Issues: If potential violations are identified, it is important to address them promptly and take corrective action. This may include returning overpayments or making necessary changes to billing practices.

Contact the Law Offices of Art Kalantar for Help With False Claims Act Lawsuits in California

If you are a California healthcare provider and have concerns about your compliance with the False Claims Act or other healthcare laws, call the Law Offices of Art Kalantar in Los Angeles at 310-773-0001 for practical advice and effective representation.

Facebook Twitter LinkedIn