Understanding the False Claims Act

The False Claims Act (FCA) is a federal law that imposes liability on individuals and companies who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government.

Overview of the False Claims Act

The FCA was originally enacted during the Civil War to combat fraud by suppliers to the Union Army. Since then, it has been amended several times, most notably in 1986, to strengthen its provisions and encourage whistleblowers to come forward.

Key Provisions

Liability

The FCA makes it illegal to knowingly submit false or fraudulent claims for payment to the federal government. Violators may be liable for three times the government's damages plus significant penalties for each false claim.

Qui Tam Actions

The FCA allows private individuals, known as "relators" or whistleblowers, to file lawsuits on behalf of the government. If successful, the whistleblower may receive a portion of the recovered damages.

Penalties

Penalties under the FCA can be severe, including treble damages and civil penalties ranging from thousands to tens of thousands of dollars per false claim.

Types of Violations

What is considered fraud under the False Claims Act?

Common violations include billing for services not rendered, falsifying records, submitting false cost reports, and misrepresenting the quality or necessity of services. The law covers a wide range of fraudulent activities that result in financial loss to the government.

Which of these are examples of offenses under the False Claims Act?

Examples of offenses include submitting claims for non-existent patients, double billing, upcoding (billing for more expensive services than were provided), and kickback schemes involving federal healthcare programs.

What are the three major categories of false claim act cases?

False Claims Act cases generally fall into three categories: healthcare fraud (such as Medicare and Medicaid fraud), defense contractor fraud, and procurement fraud involving other government programs and contracts.

Legal Process

What is the burden of proof under the False Claims Act?

To establish liability under the FCA, the government or relator must prove that the defendant knowingly submitted a false claim. The standard of proof is "preponderance of the evidence," meaning it is more likely than not that the violation occurred.

Investigation and Litigation

Once a qui tam action is filed, the government investigates the allegations and decides whether to intervene. If the government declines, the whistleblower may proceed with the case independently.

Conclusion

The False Claims Act remains a powerful tool in the fight against fraud. Its provisions incentivize whistleblowers and hold wrongdoers accountable, protecting taxpayer dollars and the integrity of government programs.