Which of the following is NOT a key element of the FCA?

• A. The claim submitted to Medicare.
• B. The misrepresentation was material to payment.
• C. The submitter knew or acted with reckless disregard of falsity.
• D. The claim was accurate and truthful.

Answer: (D)

Understanding what makes a claim actionable under the False Claims Act is being tested here. Under the FCA, liability arises when a claim is submitted to a government program like Medicare that is false, meaning there is a misrepresentation in the claim. The element that the misrepresentation is material to payment matters because the false statement must have a natural tendency to influence the payment decision. The person submitting the claim must know it’s false or act with reckless disregard of falsity, showing intent or at least conscious disregard.

The option that states the claim was accurate and truthful is not a feature that creates FCA liability; if a claim is truly accurate, there’s no false claim to trigger the act. In other words, accuracy means there’s no misrepresentation to base liability on, so it’s not a key element.