Is False Billing a Federal Crime? It Can Be in Certain Situations

The federal government has a longstanding history of collaborating with private entities, offering them contracts to carry out various tasks. Consequently, these contracts generate considerable revenue for many businesses. However, with these benefits comes rigorous oversight, as the government ensures that every payment claim is accurate and honest.

Should there be any suspicion of fraudulent billing, you might find yourself facing legal action due to the Federal Claims Act (FCA). The FCA is instrumental in ensuring businesses and individuals don’t intentionally submit, or cause to submit, deceptive or inaccurate claims for government payment. Read on to learn more about this potential federal crime and contact Chambers Law Firm at 714-760-4088 if you require a free legal consultation.

The Origin and Scope of the False Claims Act

Originally conceived in the 19th century, the FCA’s primary intent was to address dishonest defense contractors. Over time, its scope broadened to target businesses and individuals that intentionally deceive governmental programs, such as Medicare, Medicaid, and other federally funded endeavors.

While the medical sector sees a significant number of these fraudulent claims, the FCA primarily focuses on claims made with the intention of wrongfully acquiring federal funds. This distinguishes it from insurance fraud, another federal crime. The U.S. Department of Justice, bolstered by tips from whistleblowers, enforces the FCA with zeal, ensuring that fraudulent claims are identified and penalized.

Understanding False Billing Within the FCA Framework

False billing is a facet of the FCA that specifically targets businesses and contractors who deceitfully bill the government for provided services. Essentially, it’s the act of knowingly presenting a claim with misleading or false details. This malpractice isn’t limited to a specific sector; it can pertain to defense, healthcare, construction, and more.

The crime isn’t just restricted to outright falsehoods. Even overlooking crucial details, like billing codes due to negligence, can be considered a violation. The essence of this federal law is to penalize those who, in various capacities, attempt to wrongfully claim funds, services, or goods from the U.S. government.

Illustrative Examples of False Billing

  • A dentist charging Medicaid for a procedure they never conducted.
  • Defense contractors obscuring costs by misclassifying items.
  • Healthcare facilities administering unnecessary treatments to exploit insurance.
  • Contractors charging for unworked hours or unused materials on government projects.

Supporting Whistleblowers: Qui Tam Lawsuits

An essential component of the FCA is its support for whistleblowers. The qui tam provision permits private citizens with knowledge of fraud to sue on the government’s behalf. Successful qui tam plaintiffs can receive a percentage of the recovered damages, ensuring that violations of the FCA are brought to light.

Potential Consequences for FCA Violations

Those found in violation of the FCA face civil lawsuits rather than criminal prosecution. The penalties can be significant, with businesses facing fines amounting to three times the fraudulent claim’s value plus additional fines per claim. Furthermore, criminal charges can lead to imprisonment and substantial fines. It’s crucial to consider the Federal Sentencing Guidelines, which vary based on the claimed amount, even if the claim was identified as fraudulent and not paid out.

Defending Against False Billing Accusations

For a false billing charge to stand, there must be evidence of intentional deceit. Hence, defenses often hinge on proving the absence of intent or knowledge, misunderstandings regarding payment conditions, or genuine errors made in good faith. Demonstrating that the claim was either correct or submitted without the knowledge of its inaccuracy can provide a valid defense. Other defenses might include duress, entrapment, or pointing out flaws in the investigation process.

If you or someone you know is facing an investigation for false billing, Chambers Law Firm‘s federal criminal defense lawyers are here to guide you. By reaching out to us at 714-760-4088, you can explore avenues to negotiate a favorable resolution and avoid the harshest penalties. We are here to serve and ensure your rights are protected.

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