False Claims Act - Medical Coding

False Claims Act - U.S. Department of Health and …

https://oig.hhs.gov/newsroom/oig-podcasts/false-claims-act/

Examples of health care claims that may be false include claims where the service is not actually rendered to the patient, is provided but is already provided under another claim, is upcoded, or is not supported by the patient's medical …

Fraud & Abuse Laws - Office of Inspector General

https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/

Medicare Fraud & Abuse: Prevent, Detect, Report

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244-Print-Friendly.pdf

in incorrect coding, ordering excessive diagnostic tests, upcoding, or billing for services or supplies not provided may be subject to administrative, civil, or …

The False Claims Act and Fraudulent Medical Billing

https://www.hg.org/legal-articles/the-false-claims-act-and-fraudulent-medical-billing-20238

The False Claims Act can also recognize liability when the healthcare provider who provides medical services misrepresents his or her credentials. This can result …

Are Auditors, Billers, and Coders Liable for False Claims?

https://www.aapc.com/blog/34826-are-auditors-billers-and-coders-liable-for-false-claims/

The False Claims Act (FCA) imposes liability on anyone who knowingly presents, or causes to be presented, a false or …

Understanding False Claims Act in Healthcare

https://www.medicalbillersandcoders.com/blog/false-claims-act-in-healthcare/

The False Claims Act (FCA) in healthcare (also called the ‘Lincoln Law’), is a federal law that imposes liability on persons and companies who defraud governmental …

The False Claims Act - United States Department of Justice

https://www.justice.gov/civil/false-claims-act

The FCA provided that any person who knowingly submitted false claims to the government was liable for double the government’s damages plus a penalty of $2,000 …

What Kinds of Billing and Coding Errors Constitute …

https://federal-lawyer.com/what-kinds-of-billing-and-coding-errors-constitute-health-care-fraud/

Adding modifiers inappropriately (e.g., adding Modifier 25 to Code L8679 for a P-Stim procedure) can trigger scrutiny under the False Claims Act as well. 4. Unbundling The federal healthcare billing program guidelines …

Hospitals’ Significant False Claims Act Settlements

https://www.insidethefalseclaimsact.com/2021-recap-hospitals-false-claims-act-settlements/

2021 Recap: Hospitals’ Significant False Claims Act Settlements By Hannah Webber on January 21, 2022 Posted in Hospitals, Quarterly Case & Settlement Updates, …

Clinically Inaccurate Diagnoses v. Clinically Accurate …

https://www.insidethefalseclaimsact.com/medicare-advantage-plan-false-claims-act/

In the government’s view, clinically accurate diagnoses that fail to meet certain nonbinding, subregulatory guidance, such as ICD coding guidelines, are false because they violate a legal condition of payment. …