Federal False Claims Act
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Statute and Penalties
The False Claims Act (FCA) is a federal statute that applies to certain conduct. The
statute provides that any person who knowingly submits a false healthcare claim to the
government or causes another to submit a false healthcare claim to the government or knowingly
makes a false record or statement to get a false claim paid by the government is liable. Anyone
who violates the False Claims Act must pay a civil penalty ranging from $5,000 to $10,000 for
each false claim plus up to three times the amount of damages which the Federal government
sustains because of the act of the person (this is known as “treble damages”).
Individuals can also be prosecuted criminally under the False Claims Act statute when
the conduct warrants it. In these cases, the Department of Justice will pursue penalties that
include significant fines and jail time for violators.
False Claims Act cases in the healthcare industry may include:
Civil Investigative Demand
Often, these matters start with a Civil Investigative Demand. Section 3733 of the statute authorizes the Attorney General to issue a Civil Investigative Demand requiring a person to produce documents, answer written interrogatories, and/or give oral testimony whenever the Attorney General has reason to believe that a person may be in possession, custody, or control of documentary material or information relevant to a false claim.
Anyone served with a Civil Investigative Demand should retain counsel immediately. Healthcare attorneys who have experience with False Claims Act cases should carefully review the Civil Investigative Demand to ensure that it does not violate the statute.
Specifically, a healthcare attorney should:
Qui Tam and Whistleblowers
Federal and state governments and insurance carriers routinely target healthcare providers who are suspected of fraudulent conduct, including the submission of false claims for payment. Often, these cases start with a qui tam action filed by a whistleblower. Whistleblowers can be a disgruntled current or previous employee or a patient. The U.S. government can also target suspected violators after having investigated other health care providers, manufacturers of medical equipment and supplies, or management consultants.
Submission of false healthcare claims for payment under the Medicare and Medicaid program is an extremely dangerous matter. Allegations of conduct prohibited under the False Claims Act requires representation by experienced healthcare attorneys.
The Martin Law Firm healthcare attorneys are ready to help you respond to Civil Investigative Demands, allegations of False Claim violations and government interventions on qui tam claims.
Our legal team provides individualized legal solutions for our clients by offering high quality legal counsel and representation in diverse areas of law. Our attorneys regularly represent clients throughout Southeast Pennsylvania, including Montgomery County, Bucks County, Chester County, Delaware County, and Philadelphia County.
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