False Claims Act
Federal statute (31 USC 3729-3733) that imposes liability on persons and companies who defraud federal programs.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Compliance Program
- Primary sources
- 1
- Workspace handoff
- compliance binder →
Where this comes up
Compliance committees and practice managers operate at this level — written policy, workforce training, sanction policy, monitoring and auditing cadence, response and corrective action. The seven elements of an effective compliance program (OIG) are the scaffolding; this term lives somewhere on that scaffold.
Full definition
What it is in practice
The False Claims Act imposes treble damages and per-claim penalties. Qui tam provisions allow whistleblowers to file suit on behalf of the government. The FCA is the primary federal tool against healthcare fraud.
How it shows up in your practice
Pattern-of-conduct issues — systematic upcoding, billing for undelivered services, kickback arrangements — drive most FCA cases. Treat audit findings as triggers for corrective action and, when appropriate, OIG self-disclosure.
Sources
- DOJ — False Claims Acthttps://www.justice.gov/civil/false-claims-act
Document FCA training in the Compliance Binder
Open compliance binder →Related terms
- Compliance ProgramAnti-Kickback Statute (AKS)Federal criminal statute (42 USC 1320a-7b(b)) that prohibits offering, paying, soliciting, or receiving remuneration to induce or reward referrals for items or services payable by federal health programs.
- Compliance ProgramStark LawFederal statute (42 USC 1395nn) prohibiting physicians from referring Medicare/Medicaid patients for designated health services to entities with which the physician has a financial relationship, unless an exception applies.
- Compliance ProgramOIG Self-DisclosureThe HHS-OIG Self-Disclosure Protocol allowing providers to disclose actual or potential violations of federal fraud and abuse laws.
- Compliance Program60-Day Overpayment RuleACA requirement that Medicare and Medicaid overpayments be reported and returned within 60 days of identification.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- Glossary60-Day Overpayment RuleACA requirement that Medicare and Medicaid overpayments be reported and returned within 60 days of identification.
- GlossaryAnti-Kickback Statute (AKS)Federal criminal statute (42 USC 1320a-7b(b)) that prohibits offering, paying, soliciting, or receiving remuneration to induce or reward referrals for items or services payable by federal health programs.
- GlossaryOIG Self-DisclosureThe HHS-OIG Self-Disclosure Protocol allowing providers to disclose actual or potential violations of federal fraud and abuse laws.
- GlossaryStark LawFederal statute (42 USC 1395nn) prohibiting physicians from referring Medicare/Medicaid patients for designated health services to entities with which the physician has a financial relationship, unless an exception applies.
- RegulationFalse Claims Act Overview (31 USC 3729)The principal civil fraud statute for healthcare: prohibits knowingly presenting false claims to the federal government, with treble damages, per-claim penalties, qui tam relator actions, and integration with AKS and Stark.
- GlossaryWhistleblower (Qui Tam)Under the False Claims Act, a private person who files suit on behalf of the United States alleging fraud and shares in the recovery.
- BillingWhat to Do When a Payer Says You're UnderbillingGot a letter saying you're underbilling? Here's what it actually means, whether you should worry, and what action to take.
- ComplianceAmbulatory Surgery Center Compliance: CMS + State + Infection Control42 CFR Part 416 Conditions for Coverage, CMS State Operations Manual Appendix L, the ASC Infection Control Surveyor Worksheet, and where state ASC licensure tightens the standard.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.