title: Are you committing health care fraud under the False Claims Act? The answer may not be as simple as you think.
abstract: Health care fraud has a significant financial effect on the operations of the American health care system. Governments and insurers are intent on quashing such fraud and have instituted massive efforts to indict and punish offenders as well as recover major monetary awards. This article provides examples of fraudulent practices and details the definitions of fraud and abuse. In addition, it characterizes the concept of qui tam that allows whistleblowers to share in any financial awards. Finally, it highlights the importance of proper coding as a means of reducing the suspicion of fraud or abuse.
authors.affiliation: Goldberg & Frankenstein, LLC, 222 South Riverside Plaza, Suite 810, Chicago, IL 60606, USA. mgoldberg@gf-lawoffice.com
authors.forename: Michael K
authors.initials: MK
authors.lastname: Goldberg
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D005607:Fraud / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence*; D016365:Liability, Legal; D006278:Medicare; D011216:Practice Management, Medical / Q000331:legislation & jurisprudence*; D014481:United States