ICD10monitor June 7, 2023
The U.S. Supreme Court ruled on a False Claims Act (FCA) case last week. As you probably know, the FCA makes it illegal for a healthcare provider to submit for reimbursement a false claim. For example, submitting a claim for someone who does not exist – that would be a false claim.
Last week the Supreme Court clarified the standard. It ruled that the liability in the FCA depends on whether the defendants believed their claims were false, and not whether they had made an “objectively reasonable” interpretation of law or regulation.
This is so interesting because of two cases I recently defended: a) a group of physicians were accused of billing 99214s when the claims should have been 99213s,...
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