Certified Inpatient Coding (CIC) Practice Exam

Which of the following may constitute a violation of the False Claims Act?

1. Unknowingly submitting a false claim to the government.

2. Deliberate ignorance of the claim's truth or falsity.

3. Reckless disregard of the truth on a claim.

4. All of the above except the first.

The correct answer is: All of the above except the first.

The False Claims Act is designed to combat fraud against the government, particularly in healthcare and other government contracts. It establishes liability for parties that submit false claims for payment. Each of the scenarios described can lead to a violation of the False Claims Act: Unknowingly submitting a false claim to the government can be considered a violation under the Act, especially if the submitter was negligent in ensuring that the claim was accurate. However, the Act has more stringent controls for behaviors like deliberate ignorance or reckless disregard for the truth. Deliberate ignorance implies a conscious choice to avoid finding out information that would confirm a claim's falsity, which violates the principles of honesty and integrity expected in claims submissions. Reckless disregard refers to a situation where a person submits a claim while being aware that there is a substantial risk that it might be false, yet they choose to ignore that risk. This behavior also constitutes a violation of the Act, as it demonstrates a lack of due diligence and responsibility. The comprehensive interpretation is that all these actions—unknowingly submitting a false claim, exhibiting deliberate ignorance, and showing reckless disregard—can lead to legal repercussions under the False Claims Act. Therefore, since the first option doesn't inherently violate the Act in the same way that the