Corporate Compliance

Tip: Examples of False Claims Act violations

Compliance Monitor, April 30, 2008

A wide range of activities are illegal under the False Claims Act. The diverse situations that have been litigated under the act include:
  • Billing for services not rendered
  • Double billing
  • Upcoding
  • Misrepresenting diagnoses to justify services provided
  • Billing for services not covered by Medicare as a covered service
  • Performing and billing services not medically necessary
  • Submitting claims for payment for services that fail to meet regulatory standards of care
  • Submitting claims for services where the quality was so poor as to be deemed worthless
  • Admitting unnecessary patients to psychiatric facilities
This tip was adapted from The Healthcare Compliance Professional’s Guide to the False Claims Act. For more information about the book or to order your copy, click here.


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