In-house counsel and business executives: You can no longer afford the luxury of assuming that the civil False Claims Act will never apply to your business. The FCA prohibits the submission of false claims for payment or false statements that support payment from federal payors such as Medicare and Medicaid. The FCA has extremely steep penalties attached, as well as a whistleblower provision that allows individuals to bring claims and then collect a piece of the penalties. It is the primary tool used by the government to eliminate fraud in connection with federal health care programs, and has been used in virtually every segment of the health care industry. Recent changes to the FCA have broadened its reach so much that it has become crucial for those in any business that may touch health care, such as lenders or contractors for health care services, to understand the basics.
The Range of Potential Violators Has Broadened
Even before recent amendments, the FCA imposed liability for participation in a conspiracy to submit a false claim for payment by a federal payor or to otherwise violate any portion of the FCA. This provision allowed enforcement against businesses that partnered with health care, but were not themselves submitting claims or providing care.
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