Additionally , while the False Claims Act is a civil law , providers may face criminal penalties if they violate other related fraud laws . The False Statements Act carries criminal sentences for anybody who knowingly and willfully makes false statements or covers up material facts . Criminal wire fraud and mail fraud charges are also possible . Parties who engage in kickbacks or bribes in return for Medicare referrals may violate separate criminal laws .
In the case of False Claims Act , an ounce of prevention can be worth millions saved in civil fines . The US Health and Human Services Office of Inspector General provides some useful resources for physicians to comply with these laws , especially small group or solo practices who may lack access to a compliance officer . For resources , see oig . hhs . gov / compliance / physician-education / compliance-programs-for-physicians and oig . hhs . gov / compliance / physician-education / where-to-go-for-help .
References
1 . U . S . Department of Justice , Health Care Crimes Task Force , January 18 , 2022 , https :// www . justice . gov / usao-ndwv / healthcare-crimes-task-force .
2 . National Health Care Anti-Fraud Association , The Challenge of Health Care Fraud , https :// www . nhcaa . org / tools-insights / abouthealth-care-fraud / the-challenge-of-health-care-fraud /.
3 . 31 U . S . C . § 3729 .
4 . 31 U . S . C . 3729 ( b )( 1 ).
5 . U . S . v . Krizek , 111 F . 3d 934 ( D . C . Cir . 1997 ).
6 . Id . at 942 .
7 . National Law Review , Top 5 Notable Qui Tam Lawsuits of 2021 , February 16 , 2022 , https :// www . natlawreview . com / article / top- 5-notable-qui-tam-lawsuits-2021 .
8 . 31 U . S . C . 3730 ( h ).
9 . 18 U . S . C . § 1001
10 . 18 U . S . C . § 1341 governs mail fraud . 18 U . S . C . § 1343 governs wire fraud .
11 . 42 U . S . C . § 1320a-7b .
AUTHOR
Valarie Blake , JD , MA
West Virginia Medical Journal • June 2022 • 15