Reverse False Claims  

Category: Billing

Health care providers are generally well aware that they can find themselves in a considerable amount of trouble if they submit false claims to the government. The False Claims Act subjects a person to liability for knowingly presenting, or causing the presentation of a false claim to the government for payment. It also extends liability to the person who knowingly makes or causes a false record or statement which is material to a false claim presented to the government for payment. A "traditional" false claim involves the physician's (or provider's) receipt of a government payment from the submission of a claim that was "knowingly" false. The "false certification" of a submitted claim is one theory of liability under the False Claims Act. In this situation, the physician falsely certifies compliance with a Medicare statute or regulation, where payment is expressly condition...