The Federal False Claims Act FCA) makes it illegal to submit false or fraudulent claims for payment to Medicare or Medicaid or other federal health care programs. Claims may be false if the service is not actually performed, has already been billed under another claim, is miscoded, or is not supported by the medical record.
Florida also has its own False Claims Act
Penalties
Federal False Claims Act violations can result in fines up to three times the program’s loss, plus $5,500 - $11,000 per claim. Fines add up quickly because each claim can be a separate ground for liability. State Law imposes additional penalties.
A FCA investigation is one of the primary tools used by the government to identify and prevent false or fraudulent claims to the government.
Your role is to prevent false or fraudulent claims through accurate
documentation in the patient’s medical record.