Allegations of fraud can have significant consequences for health care providers. Not only are there potential civil penalties that can result from fraud allegations, but there possible criminal penalties as well. On the civil side, depending on the facts of the case and the law being applied, a provider could face tens or hundreds of thousands of dollars in penalties.
One of the major federal laws under which health care providers accused of fraud are penalized is the False Claims Act. Under the law, the minimum penalty for fraudulently submitting a claim to a federal program is $5,500 per claim. The maximum is $11,000 per claim. Those numbers, though, could possibly double in the near future.
The U.S. Railroad Retirement Board, the federal agency responsible for administering retirement-survivor and unemployment benefits for railroad workers, recently released an interim final rule increasing the maximum and minimum penalties for submitting false claims to nearly doubt what they are currently. The rule does not apply to False Claims Act cases in general, but experts say it suggests that the government may be moving in the direction of increasing civil penalties.
One of the effects of increasing penalties under the False Claims Act, commentators have pointed out, is that defendants may have more motivation to accept settlement offers from the government rather than fighting them in court.
Health care fraud, of course, can also lead to criminal penalties as well. In a future post, we’ll look at this issue and why it is important for health care providers to work with an experienced criminal defense attorney when they are facing government investigation or charges.