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LEGAL UPDATE
Jennifer L. Weaver, JD
Hard Truth About the False Claims Act
The federal government is increasingly targeting billing fraud.
T
he U.S.
False Claims
WARNING SIGNAL The federal False Claims Act enables
— and often motivates — whistleblowers to expose fraudulent practices.
Act is the
federal government's most effective tool against
healthcare fraud. It
makes it illegal to
submit fraudulent payment claims to the federal government, and
lets whistleblowers file lawsuits against those who they claim have
done so. Owing to the huge amount the government spends through
its Medicare and Medicaid programs, healthcare providers are by far
the No. 1 target of FCA litigation.
Just ask the Princeton (Ind.) Surgery Center, named 2 years ago in a
False Claims lawsuit alleging fraudulent billing practices. The whistleblower was the former chief financial officer at nearby Gibson
General Hospital, who filed a complaint against the hospital, the ASC,
9 physicians and a nurse anesthetist, accusing his hospital of handling
billing for the ASC in order to increase payments from Medicare and
Medicaid. The lawsuit claims the hospital submitted about 65 false
claims per month to Medicare for nearly 2 years, causing the government to lose an estimated $2,100 per claim. The ASC and the hospital
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