Chapter 5: Key Laws in Healthcare Compliance

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False Claims Act

Fast Facts

Title of law: False Claims Act, civil actions for false claims, false claims procedure, false claims jurisdiction, civil investigative demands

Categories:

  • Fraud and abuse

  • Medicare

  • Medicaid

U.S. Code: 31 U.S.C. §§ 3729–3733

Year enacted: 1863

Major amendments: 1943, 1986, 2009, 2010

Enforcement agencies: U.S. Department of Health & Human Services Office of Inspector General, U.S. Department of Justice

Links to full text of law:

Applies to: Fraud involving any federally funded contract or program, with the exception of tax fraud. Concerns to healthcare include upcoding, off-label promotion, Medicaid rebates, failure to document patient care, deficient compliance, worthless services, and improperly retaining overpayment from a government healthcare program.[5]

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