Health care in the United States is expensive. This can be made worse by those who choose to file false claims for medical services that never took place or that didn't need to take place.
The government takes fraud very seriously. It uses the False Claims Act to hold people accountable for making fraudulent claims against the government. The FCA has penalties of up to $10,000 for each false claim that is made, which are in addition to the damages that can be paid, which are up to three times the damages the government actually suffered.
Why does the FCA have such high penalties?
The hope is that the high penalties will make people avoid making false claims. Additionally, the high penalties make it possible for individuals who alert the authorities to false claims taking place to receive up to 30 percent of the funds recovered by the government.
What are some types of health care fraud?
Some examples include:
- Billing for each step of a procedure individually instead of as a group, which is known as unbundling. This costs more than charging a bundled rate.
- Forging signatures
- Misrepresenting locations, providers or dates of services
- Falsifying a diagnosis to justify service or treatments
- Waiting for deductibles and co-payments
- Tempering with a patient's medical records
Each of these things can end up costing the government a lot of money, which is why they're taken so seriously. It is possible to make mistakes that appear as fraud, though. If that happens, your medical license could be threatened, and you could face heavy fines.