Health care providers can avoid many legal and regulatory problems with the creation and maintenance of a Billing Fraud Compliance Plan.  

During the Civil War deterring and preventing fraud committed against the government. 

Anyone who contracts with the government, including medical providers that bill the government, are subject to the FCA.  Violating the law can lead to severe penalties, such as courts can impose treble (three times) damages for each violation. 

In other words, if there are, for example, numerous billing errors found to be fraudulent, the court can award the government treble damages for each of those errors. 

Obviously, this could quickly add up to an extremely large penalty. 

In addition to the government being able to prosecute violations, individuals can bring “whistleblower” actions resulting in the same level of penalties for which they get a reward.  While these monetary damages can cause enough harm, another concern is that these claims could lead to actions outside the FCA, including exclusion from Medicare and Medicaid , license renewal problems and even disciplinary action before the provider’s State governing body.

Lawsuits under the FCA are usually based upon incorrect billing. 

Sometimes this involves incorrect coding, billing for services not actually performed, or unbundling of services in an attempt to increase billing amounts.  While these issues may come to light in other ways, it is common to have a disgruntled former employee initiate actions for false claims.  Clearly, the best defense against a FCA allegation is prevention through a good Compliance Plan. 

Spelling out billing practices and what internal actions should be taken to deal with concerns is vital.   If, however, a medical professional faces a FCA action, it is important to have experienced, knowledgeable legal representation.  The attorneys at Rosenberg Law focus their practice on representing medical professionals and their practices and, as a result, have that knowledge and experience to provide an effective defense in a FCA action.

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