07/13/2015 // KellerGroverWB // (press release)
Medicare and Medicaid are supposed to only pay for procedures, devices and tests that were actually performed or used. Dishonest healthcare providers and organized crime have learned that with the right falsified paperwork, Medicare and Medicaid can be tricked into paying for nonexistent care and devices for fictional patients or real patients not actually cared for.
To receive payment a healthcare provider must certify the services were actually rendered and the goods were actually needed and provided. The submission of a claim for payment for health care services never provided would be a false claim and may be a violation of the False Claims Act (FCA).
The goal of the FCA is to discourage any government contractor, including a health care provider, from overcharging and falsely charging the federal government for goods or services. The law provides for civil liability of up to three times the amount of damages suffered by the government for any person who knowingly submits, or causes to be submitted, a false or fraudulent claim for payment to the Federal government. For the submission to be “knowing” the person must have actual knowledge or act in deliberate ignorance or reckless disregard of the truth or falsity of the information.
The FCA also provides for civil penalties of $5,500–$11,000 per false claim.
