Most doctors bill their Medicare claims correctly. However, there are a few physicians – and their employers – who engage in upcoding and similar activities and risk the harsh penalties of the False Claims Act (FCA).
Brief history of the FCA
As many of our Michigan blog’s readers know, the Department of Justice (DOJ) last year increased the penalties that can be assessed under the FCA – a federal statute that dates back to 1863. In fact, the FCA was enacted during the Civil War to stem defense contractor fraud.
Today, the statute enables the federal government to pursue perpetrators of fraud, and it also allows private citizens to file lawsuits (called “qui tam” suits) on behalf of the government against those who’ve defrauded the government. The citizens who do so successfully are eligible to receive part of the recovery.
The Department of Justice says that in the fiscal year that ended Sept. 30 of last year, it received more than $2.2 billion in settlements and judgments in cases involving false claims and fraud.
Breaking down the numbers
According to the DOJ, there were 672 qui tam lawsuits filed in the 2020 fiscal year, and only 250 non-qui tam suits. The government recovered $545,330,030 in non-qui tam lawsuits and $1,686,124,824 in qui tam suits.
Both figures were down substantially from fiscal 2019’s non-qui tam ($844,282,697) and qui tam ($2,239,229,732) totals.
In June of last year, the DOJ announced that the minimum penalty for a single false claim under the FCA rose from $11,181 to $11,665 and the maximum penalty went from $22,363 up to $23,331.
The DOJ also updated other assessable civil penalties under the Anti-Kickback Statute, the Americans with Disabilities Act and the Program Fraud Civil Remedies Act.
It is not clear if the DOJ will adjust penalties again this year.