False Claims Act Essay

Author Safian defines the False Claims Act “law specifically forbids the transmission of claims with the intention of gaining reimbursement under false conditions” (Safian, 2009). This means that when a claim is submitted with false information to increase reimbursement it violates the False Claims Act. This behavior also can be identified as intentional and will be considered as fraud. There are heavy consequences for violating this Act and the behavior associated with violation should not be taken lightly.
One major deterrent for this behavior is that the penalty can result in fines up to three times the actual balance of the claim. Of course, there can be imprisonment along with the fines when this act has been violated. Another major aspect that I feel is important is the Qui Tam provision, which is also known as the “whistleblower”. This will encourage others to report any violations to proper authorities that may include a reward any monies recovered. This is can be accomplished when a patient notice improper charges on their explanation of benefits or statements. Also, this will encourage coders and billers the privacy of and support for reporting any findings that they fell may or not be improper.
If the physician knowingly document treatment and procedures that he or she know that they did not perform to receive a large reimbursement, this is a violation. A physician’s office is held to the same standards are an organization. However, a hospital can violate the False Claims Act by not reporting or returning overpayments that may have been received. When I worked in a hospital, at the end of the year a report was created to be submitted to Center of Medicaid and Medicare for annual cost. An organization can violate the False Claims Act by not reporting any