One of the many regulations governing health care fraud is the False Claims Act (FCA). The FCA was originally enacted in 1863 to protect the United States government from being defrauded while buying supplies for the army during the Civil War. While it has gone through many changes and amendments in the last 150 years, the underlying principle remains the same: Any entity knowingly submitting false claims to the government is liable for the damage plus a penalty. Claims submitted to government health care programs such as Medicare and Medicaid are included in FCA regulations.
In 2015, the Department of Justice announced new regulations which increased the civil penalties under the FCA and allowed for annual inflation adjustments to the penalties. For claims that occurred after November 2, 2015, the minimum penalty per claim jumped from $5,500 to $10,781. The maximum per claim increased from $11,000 to $21,563. The inflation adjustment now results in a minimum per claim of $10,957 and a maximum of $21,916.
It’s important to note that the maximum penalty of $21,916 is separate from the fines incurred for the false claim, which can be up to three times the damage sustained by the government. Criminal penalties, including fines and/or imprisonment, may also apply.