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Federal and State Regulations ____________________________________________________
The False Claims Act , 31 U . S . C . §§ 3729 - 3733
The False Claims Act ( FCA ) is one of the laws the federal government uses to prevent and detect fraud , waste , and abuse in federal health care programs . The FCA provides that anyone who “ knowingly ” submits a false claim to the Government is liable for damages up to three times the amount of the erroneous payment , mandatory penalties between $ 5,500 and $ 11,000 for each false claim submitted , and potential administrative remedies , such as exclusion from future participation in government health care programs .
The FCA defines “ knowingly ” to mean that a person ( 1 ) has actual knowledge of the false claim ; ( 2 ) acts in deliberate ignorance of the truth of the falsity of the information ; or ( 3 ) acts in reckless disregard of the truth or falsity of the information .
Specifically , there are seven ( 7 ) actions that may form the basis for liability under the federal False Claims Act including :
• Knowingly presenting , or causing to be presented , a false or fraudulent claim for payment or approval by the federal Government ;
• Knowingly making or using , or causing to be made or used , a false record or statement to get a false claims paid or approved ;
• Conspiring to defraud the Government by getting a false or fraudulent claim allowed or paid ;
• Knowingly making , using , or causing to be made or used , a false record or statement to conceal , avoid , or decrease an obligation to pay money or transmit property to the Government .
• The FCA applies to claims submitted for payment by a federal health care program , physician or other care provider who participate in federally funded programs such as Medicare and Medicaid .
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