What Is False Claims Act?
The False Claims Act (31 USC 3729-3733) is a federal law imposing civil liability on any person who knowingly submits, or causes to be submitted, a false or fraudulent claim for payment to the U.S. government, with treble damages plus per-claim civil penalties.
False Claims Act
Also known as: FCA; 31 USC 3729-3733; Lincoln Law
The False Claims Act (31 USC 3729-3733) is a federal law imposing civil liability on any person who knowingly submits, or causes to be submitted, a false or fraudulent claim for payment to the U.S. government, with treble damages plus per-claim civil penalties.
Definition
The FCA imposes liability on persons who knowingly present false claims, make false records material to a false claim, or knowingly conceal an obligation to pay the government. 'Knowingly' includes actual knowledge, deliberate ignorance, and reckless disregard. The statute permits qui tam suits where private whistleblowers (relators) sue on behalf of the government and receive 15-30% of recoveries. Per-claim penalties range from approximately $13,946 to $27,894 (2024 inflation-adjusted) plus treble damages. Healthcare accounts for the largest share of DOJ FCA recoveries — $2.68 billion of the $2.91 billion total in FY 2023.
Example
Submitting Medicare claims for E/M services at a higher level than documentation supports (upcoding), billing for services not rendered, billing duplicate claims, or unbundling services that should be billed together can each constitute FCA violations. Knowingly retaining a Medicare overpayment beyond 60 days after identification (the '60-day rule' under the ACA) is also an FCA violation.
Common Misconceptions
The FCA does not require intent to defraud — reckless disregard or deliberate ignorance is enough. A 'mistake' is no defense if the practice failed to implement reasonable compliance controls. AKS violations are per se FCA violations under the 2010 ACA amendment, meaning kickback-tainted claims are automatically false claims.
Practical Application
Billing companies and practices should maintain a documented compliance program with regular coding audits, a confidential reporting channel for staff concerns, prompt investigation of identified overpayments, and timely refund of identified overpayments within the 60-day window to avoid FCA exposure.
Related Terms
Anti-Kickback Statute
The Anti-Kickback Statute (42 USC 1320a-7b(b)) is a federal criminal law prohibiting the knowing and willful offer, payment, solicitation, or receipt of any remuneration to induce or reward referrals of items or services payable by a federal health care program.
Read definition arrow_forwardStark Law
The Stark Law (42 USC 1395nn) is a federal civil statute prohibiting physicians from referring Medicare or Medicaid patients for designated health services to entities with which the physician (or an immediate family member) has a financial relationship, unless an exception applies.
Read definition arrow_forwardHIPAA
HIPAA is the 1996 federal law that establishes national standards for protecting the privacy and security of individually identifiable health information held by covered entities and their business associates.
Read definition arrow_forwardWhere This Applies on MedPrecision
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