Can Your Medical Opinion Subject You to Criminal or Civil Liability?: Recent Federal Cases Involving Medical Opinions and False Claims

摘要

When providing health care services that are reimbursed by federal health care programs (i.e., Medicare and Medicaid), or other third party payers, providers must comply with a number of health care fraud and abuse laws, including the False Claims Act and a number of criminal statutes, including a statute specifically addressing healthcare fraud. The False Claims Act (FCA) imposes civil liability on those who present, or cause to be presented, a false or fraudulent claim for payment to the federal government.1 While the FCA imposes civil liability, there are separate criminal statutes that can be used by the government to prosecute false claims and healthcare fraud.2