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Physicians, Medicare fraud and the False Claims Act

| Feb 24, 2021 | Firm News |

As a busy physician, you may be part of a large practice. You see many patients on a daily basis and depend on others to keep day-to-day operations running smoothly.

If the federal government suspects that an illegal activity like Medicare fraud is underway in your practice, you can face heavy fines and more serious penalties under the False Claims Act.

How Medicare fraud works

Medicare fraud can occur in a number of ways, including:

– knowingly submitting false claims

– misrepresenting facts to obtain a healthcare payment from Medicare

– billing Medicare for services, medical supplies or equipment not provided

– billing Medicare for appointments that patients did not keep

About the FCA

The goal of the civil False Claims Act or FCA is primarily to protect the federal government from being overcharged. Penalties for filing false claims could result in fines equal to three times the loss sustained by a federal program such as Medicare plus another $11,000 for each claim filed.

Federal prosecution

Several government agencies can prosecute cases involving Medicare fraud including the Department of Justice, the Health and Human Services Offices of Inspector General and the Medicare Fraud Strike Force. An investigation into this kind of fraud normally takes months if not years, and as a doctor, you may eventually become aware that you are a target. The time to begin building a defense strategy is when you first sense that an investigation into Medicare fraud is imminent. A proactive stance is the best way to protect your medical license, your career and your professional integrity.