What Tyler Health Care Providers Should Know About the False Claims Act

The federal False Claims Act is the government’s main tool for recovering money paid on improper Medicare and Medicaid claims. For hospitals, physician groups and other health care providers in Tyler and East Texas, the stakes are high. Liability can include three times the government’s losses plus a civil penalty for each false claim.

What Counts as a False Claim

A claim can be false if it bills for services not provided, upcodes, bills for medically unnecessary care, or results from a referral that violated the Stark Law or Anti-Kickback Statute. The law covers knowing conduct, which includes reckless disregard, not just intentional fraud.

Qui Tam Whistleblower Suits

Private individuals, often current or former employees, can file a qui tam lawsuit on the government’s behalf and share in the recovery. These cases are filed under seal while the government investigates, so providers may not know about them for months.

The 60-Day Overpayment Rule

Providers who identify a Medicare or Medicaid overpayment must report and return it within 60 days. Holding on to a known overpayment can itself create False Claims Act liability.

If You Receive a Government Inquiry

• Do not ignore it or respond without counsel.
• Preserve relevant records and suspend routine deletion.
• Limit internal discussions and route questions through your attorney.
• Assess whether a self-disclosure makes sense.

Lindsey Birdsong has successfully defended health care facilities in qui tam suits and represented providers in corrective action plans responding to CMS notices of termination.

Frequently Asked Questions

Can an employee file a False Claims Act case against my practice?

Yes. Current and former employees are the most common qui tam relators. Retaliating against a whistleblower creates additional liability.

Is a billing mistake a False Claims Act violation?

An honest mistake is not, but ignoring warning signs or failing to return a known overpayment can create liability.

Talk With a Tyler Attorney

Facing a government inquiry or billing concern? See our health care law services. Call Lindsey Birdsong, PC at (903) 595‑6297 or visit our contact page. Our office is at 2307 Dueling Oaks Drive, Suite 103, in Tyler.

This article is general information, not legal advice. Talk with an attorney about your specific situation.