The False Claims Act prohibits knowingly presenting false or fraudulent claims for payment, making false statements material to such claims, and retaining overpayments. Knowledge includes actual knowledge, deliberate ignorance, and reckless disregard.
Damages are trebled and civil penalties attach per claim, which in healthcare can mean per individual bill.
Alternative Names:
FCA, Federal False Claims Act
Why it Matters?
Per-claim penalties are what make FCA exposure disproportionate to actual harm, since a billing practice applied across thousands of encounters generates penalties dwarfing the underlying overpayment. Following Escobar, materiality has become the central defense, particularly the argument that the government continued paying with knowledge of the alleged noncompliance. That inquiry makes government payment history essential discovery.
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Related terms
Frequently asked questions
Why are FCA penalties so large relative to the loss?
What is the materiality defense?
