Medical Auditing Practice Exam

Which type of case is not prosecuted under the federal False Claims Act?

1. Healthcare fraud

2. Medicaid overbilling

3. Physician tax issues

4. Pharmaceutical fraud

The correct answer is: Physician tax issues

The correct choice revolves around the specifics of what the federal False Claims Act addresses. This law is primarily focused on fraud involving government programs, particularly in healthcare. It allows individuals to file actions against entities that are suspected of defrauding federal programs or contracts. Healthcare fraud, Medicaid overbilling, and pharmaceutical fraud all relate directly to claims made to Medicare or Medicaid, both of which involve federal funds. They are directly prosecutable under the False Claims Act because they involve fraudulent claims made to the government, thus qualifying as violations of this act. On the other hand, physician tax issues typically do not fall under the purview of the federal False Claims Act. These issues usually pertain to tax compliance and regulations rather than fraudulent claims against federal programs. Therefore, they lack the direct relation to federal funds or programs that would justify prosecution under this specific act, leading to the understanding that such cases are not prosecuted under the federal False Claims Act.