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What medical employees should know about the False Claims Act

Working in the healthcare industry means assuming a position of trust with both the public and the businesses that you interact with in a professional capacity. Whether you are a physician's assistant, a nurse, a medical billing specialist or a receptionist, the people you interact with trust you in part because of your involvement in the medical field.

Unfortunately, not everyone working in medicine pursues the career out of a sense of duty to the greater good of society or people. Some people get into medicine because they want to make a lot of money, and for those people, even the amount of money a physician makes may not seem like enough.

Individuals, as well as entire medical practices, can get involved in a conspiracy to commit fraud through inaccurate and illegal billing practices. Criminal charges and career consequences often result from enforcement efforts.

What is the False Claim Act?

The False Claim Act is a federal law that makes it a crime to intentionally over-bill or fraudulently bill as a service provider or contractor for the government. Hospitals and medical facilities fall under the provisions of the Act through their acceptance of government insurance programs such as Medicare and Medicaid.

Contractors and businesses that serve the government have an obligation to be fair and honest in what charges they assess and how they bill for the services or goods that they provide. However, there are many ways in which those with the authority to bill the government can abuse that trust.

Examples of common medical billing fraud include:

  • Intentionally unbundling medical services typically provided together at a discounted rate
  • Billing for services not provided
  • Performing unnecessary medical procedures on people in order to bill for them
  • Billing for a completely different procedure or treatment than the one performed

Under the False Claims Act, whistleblowers can take action

If you find out that your employer is intentionally committing billing fraud against the government and you do nothing, you could wind up implicated in any future criminal charges against the company. Even if you are not actively involved in the fraud, failing to draw attention to the crime taking place could be sufficient reason to include you among those charged.

You don't need to wait for someone else to take action against your employer or leave your job to try to protect yourself. Instead, you can decide to take action as a whistleblower. You can alert federal agencies to the fraud taking place. In some scenarios, whistleblowers can even be the ones to take action on behalf of the federal government under the qui tam provisions in the law.

In addition to protecting your professional reputation and upholding your ethical obligation to other members of the country, acting as a whistleblower under the False Claims Act also benefits you by potentially awarding you with thousands of dollars of compensation. You can receive a percentage, sometimes as high as 25%, of the fraudulently billed amount proven in court as a result of your actions.

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