False Claims Act Settlements Surpass $2.9 Billion in FY 2024: Why Certified Medical Coders with CodeEMR Matter More Than Ever
The U.S. Department of Justice (DOJ) announced that False Claims Act (FCA) settlements and judgments exceeded $2.9 billion in fiscal year 2024, rising from $2.68 billion in FY 2023. Once again, healthcare fraud – particularly related to inaccurate billing and documentation – remains a leading driver of these penalties.
As enforcement increases, healthcare organizations must take proactive steps to reduce risk. One of the most effective ways? Partnering with certified medical coding experts like CodeEMR.
What is the False Claims Act and how does it affect healthcare providers?
The False Claims Act (FCA) is a federal law that penalizes individuals or organizations that knowingly submit false or fraudulent claims to government healthcare programs like Medicare or Medicaid.
Inaccurate coding and documentation errors – even unintentional ones – can result in audits, legal settlements, and financial penalties. Partnering with certified coders like CodeEMR helps ensure billing compliance and reduce FCA risk.
Why Healthcare Facilities Are Under the Microscope
Federal agencies, whistleblowers, and commercial payers are intensifying efforts to uncover fraud and waste – particularly in Medicare and Medicaid billing. A new administration often brings shifts in healthcare policy and compliance expectations, resulting in more audits, denials, and settlements.
Many of these violations aren’t due to intentional fraud – they’re caused by documentation and coding mistakes that could have been avoided with the right support.
Are Your Coders Certified - and Do They Know What They Don’t Know?
Inexperienced or overburdened staff can unintentionally trigger False Claims Act violations. Common issues include:
- Misinterpreting E/M coding guidelines
- Missing documentation for modifiers
- Improper unbundling of services
- Overcoding based on assumptions, not documentation
That’s why it’s crucial to work with a team like CodeEMR, which provides:
- Certified professional coders (CPC, CCS, etc.) for all specialties
- Accurate, compliant coding across CPT, ICD-10, and HCPCS
- Thorough documentation reviews to reduce denials and risk
- End-to-end revenue cycle insights that align with CMS and payer regulations
Common Compliance Pitfalls That Lead to FCA Exposure
Even well-meaning providers or staff can submit false claims when coding without oversight:
👉 Billing for Services Not Rendered
Scenario: A procedure was scheduled but not performed. An E/M code was billed, but a staff member incorrectly added modifier 25 without validating documentation. The claim was resubmitted and paid-illegally.
👉 Unbundling of Services
Scenario: A preventive exam (99397) was billed alongside a well-woman exam (G0101), even though G0101 is bundled into the preventive code. The claim was edited with modifier 25 and paid—an FCA violation.
👉 Upcoding Evaluation & Management (E/M)
Scenario: A provider billed a high-level E/M for a routine prescription renewal, assuming the complexity of medications justified the level. Without evaluating all MDM components, this led to overbilling.
These are not just billing issues – they’re compliance risks with real legal and financial consequences.
Why CodeEMR Is the Right Partner for Compliance & Revenue Integrity
CodeEMR supports healthcare organizations with specialty-specific, coding teams trained to reduce errors, improve documentation quality, and ensure full compliance.
With CodeEMR, you gain:
- A proactive partner that helps prevent FCA red flags
- Improved claims accuracy and reduced denials
- Optimized revenue cycle performance
- Protection from reputational and financial damage
Whether you’re a small clinic, a hospital, or a multi-specialty group, CodeEMR provides scalable medical coding solutions that safeguard both your bottom line and your compliance standing.
Final Thoughts: Compliance Isn’t Optional - It’s Strategic
In an era where False Claims Act penalties are rising and regulatory pressure is constant, accurate medical coding is no longer a back-office task – it’s a strategic priority.
Partnering with a trusted expert like CodeEMR means:
✅ Staying ahead of audits
✅ Avoiding costly legal settlements
✅ Ensuring clean, compliant claim submissions
✅ Supporting provider workflows and reducing burnout
