If a false claim is filed, who may be held culpable under the federal False Claims Act?

Under the federal False Claims Act, any individual or entity that knowingly submits, or causes the submission of, false or fraudulent claims for payment can be held liable. This broad application of liability includes physicians, coders, and billers, as each plays a critical role in the healthcare billing process.

Physicians may be culpable if they knowingly provide false information regarding the services rendered. Coders can be held accountable if they inaccurately code diagnoses or procedures with the intent to mislead or deceive for financial gain. Billers, who prepare and submit claims based on the information provided, also share responsibility and can face liability if they knowingly submit claims that are not substantiated by appropriate documentation or coding.

This shared responsibility emphasizes the importance of diligence, accuracy, and compliance within each role in the claims process, reinforcing that anyone involved in submitting claims can be held accountable under the False Claims Act. Hence, the answer indicating that all mentioned parties may be culpable reflects the comprehensive scope of the act’s liability framework.