Every year, the government reclaims billions of dollars from illegal billing. Most of these claims involve healthcare. The False Claims Act (FCA) is a powerful law to fight against fraud, waste, and abuse.
In this module, you will learn about the purpose and benefits of the FCA. We will discuss how to report potential false claims and the penalties for violations.
Please look at the important terms before you begin.
Civil monetary penalty (CMP)
A fine charged to a facility when it violates certain laws and rules
Claim
According to the False Claims Act, “any request or demand for money or property”
Corporate integrity agreement (CIA)
An agreement made to prevent exclusion from the federal healthcare programs
Exclusion
To prevent from participating or entering a federal healthcare program
False claim
A claim for money or property that is not true or owed
Fraud
Cheating to gain money or property
Qui tam provision
Part of the False Claims Act that allows any person to file a lawsuit for the government
Retaliate
To do something against someone to get revenge
Reverse false claims
Overpayments from a federal healthcare program that are not paid back
Violation
Not following a law or rule
Whistleblower
Person who files a false claims lawsuit for the government
The False Claims Act (FCA) is a federal law that makes it illegal to send a false claim to the government. The law is effective in getting payments back that were made for false claims. This protects and benefits both federal healthcare program recipients and taxpayers.
The FCA applies to people and facilities that knew or should have known that a claim was false. Any claim that is incorrect or false can be a violation. Single mistakes are usually not treated as fraud. Repeating the same error is a violation of the FCA.
There are many ways that claims can be false. Here are examples of false claims:
