If you're billing Medicare, Medicaid, or any other federal insurance program as an occupational therapy practitioner, it's essential to understand the False Claims Act (FCA). Many assume it only applies to blatant fraud like billing for services never provided, but as highlighted in Amplify OT’s Podcast Episode 16, the law is much broader—and much more relevant to everyday practice than you might think.
What Is the False Claims Act?
The False Claims Act is a federal law that penalizes individuals or organizations who submit false or misleading claims to the government for payment. That includes claims submitted to programs like Medicare and Medicaid. While originally designed to catch intentional fraud, it also applies to cases where providers should have known that the information submitted was incorrect or misleading.
Examples of violations include:
- Billing for services that are not medically necessary
- Using incorrect CPT codes, time units, or modifiers
- Failing to return overpayments from Medicare
- Providing services without the proper licensure or supervision
- Misrepresenting how much time was spent with a patient
You don’t need to intentionally commit fraud to be found liable under the FCA. If you're reckless with billing practices or turn a blind eye to improper procedures, you could still be held responsible.
Why Occupational Therapy Practitioners Need to Know
Even small practices and independent therapists can be audited or investigated under the FCA. In fact, many claims are triggered by whistleblowers—such as current or former employees—who can file lawsuits on behalf of the government and share in any recovered funds.
Key reasons OTPs should care:
- You are responsible for the accuracy of your billing, even if someone else handles your claims
- Violations can result in steep financial penalties, exclusion from Medicare, or even criminal charges
- Not knowing the rules won’t protect you if you’re audited or investigated
The Takeaway
The False Claims Act isn't just about big fraud cases—it's about protecting public funds and ensuring accountability in healthcare. For occupational therapy professionals, it’s a reminder that compliance matters at every level, from documentation to billing to supervision. Having clear internal policies, training, and regular reviews of your billing practices can go a long way in keeping your business protected and thriving.
Expert Contributor: Clarice Grote, MS, OTR/L | Amplify OT
Clarice is an occupational therapist and the founder of Amplify OT, where she empowers OT practitioners with the knowledge and tools to navigate healthcare policy, reimbursement, and advocacy. With a background in both clinical care and health policy, Clarice is passionate about helping therapists confidently engage with the systems that impact their practice. She blends real-world experience with accessible education to ensure OTs have a seat at the table—without needing a policy degree to get there.