{"id":15488,"date":"2022-06-20T10:19:32","date_gmt":"2022-06-20T10:19:32","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15488"},"modified":"2026-05-11T14:48:49","modified_gmt":"2026-05-11T14:48:49","slug":"avoiding-false-claim-billing-for-your-practice","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/avoiding-false-claim-billing-for-your-practice\/","title":{"rendered":"Avoiding False Claim Billing for your Practice"},"content":{"rendered":"

Understanding False Claims Act<\/strong><\/h2>\n

As a healthcare practice, you can typically submit claims to Medicare or Medicaid. Your claims are bills for goods you provide and services you conduct for patients. These federal health insurance programs cover the costs associated with your services. <\/span><\/p>\n

The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded directly, in whole or in part, by the United States Government or any state healthcare system. <\/span><\/p>\n

In other words, healthcare practices must not bill the government for things they did not do. Examples of false claims include billing for services not provided, billing for the same service more than once, or making false statements to obtain payment for services.<\/span><\/p>\n

Penalties under the False Claims Act<\/strong><\/h2>\n

Violations under the federal False Claims Act can result in significant fines and penalties. Financial penalties to the person or organization include recovery of three times the amount of the false claim(s), plus an additional penalty of $5,500.00 to $11,000.00 per claim. Violation of the MMFCA constitutes a felony punishable by imprisonment, a fine of $50,000 or less, or both, for each violation. <\/span><\/p>\n

A person who receives a benefit, by reason of fraud; makes a fraudulent statement; or knowingly conceals a material fact is liable to the state for a civil penalty equal to the full amount received plus triple damages.<\/span><\/p>\n

Examples of False Claim Billing<\/strong><\/h2>\n

Healthcare fraud can involve individuals or groups of healthcare workers misrepresenting their services and ending up overcharging the government. The United States Department of Justice listed a few instances of healthcare fraud.<\/span><\/p>\n