Compliance & Reimbursement: Top-4 Bases for Liability Under the FCA

Learn These Federal No-No's and Prevent Unwitting Fraud

When the government cracks down on False Claims Act (FCA) violations, they consistently prosecute these four trip-ups. Monitor your claims carefully through each step of the submission process, or you could be accused of federal charges before you even know there's billing amiss. Keep an eye out for these transgressions:

1. Submitting false claims

According to the FCA, the government doesn't even need to prove you personally intended to defraud anyone to pin this violation on you. They hold your facility ultimately accountable, and "your facility" includes people working for you - and yes, that means third-party consultants, too. So even if your consultant is to blame for less-than-sparkling claims, you can't get away with pointing your finger at him. Because most FCA complaints are reviewed for both civil and criminal transgressions, any discovery of fraudulent intent could score you criminal liability.

2. False statements or records accompanying your claims

Proving this infraction is a little trickier. The prosecutor's burden of proof is threefold: She must prove you filed a false claim, that you created or used phony records or statements to get the claim approved, and that you performed all these acts "knowingly and willfully."

3. Conspiracy to submit false claims

This violation is composed of several conditions. You need to have the intent to defraud the government, demonstrate agreement or action toward filing a false claim, and get the false claim reimbursed by the government.

4. Reverse false claims

This rule makes liable anyone who creates or uses a fake record or statement to cover up, evade, or reduce his responsibility to remit money or property to the government.

The "knowingly and willingly" clause applies to all of these provisions, meaning that in order to be considered guilty of the offense, you must know about the information in question and either purposely ignore or recklessly disregard its truth or falsity.

- Published on 2003-08-13