Under the False Claims Act, the government has the primary responsibility for prosecuting the case.
Does the False Claim Act apply to Medicare?
The Federal False Claims Act is a federal statute that establishes liability for knowingly presenting a false or fraudulent claim for payment to the United States government or to a government contractor. This includes claims submitted to Medicare or Medicaid.
Who does False Claims Act apply to?
In addition to allowing the United States to pursue perpetrators of fraud on its own, the FCA allows private citizens to file suits on behalf of the government (called “qui tam” suits) against those who have defrauded the government.
Who is the ultimate victim for the federal False Claims Act to apply?
Fraud against the government, like any fraud, is just theft by another name. The ultimate victim is not the government: it is the hardworking taxpayer . Government funds come from taxpayers, and so theft from the government is theft from taxpayers.
Who can be a whistleblower according to the qui tam provisions in the False Claims Act?
§ 3729 et seq., which allows a private individual , or “whistleblower” (or relator), with knowledge of past or present fraud committed against the federal government to bring suit on its behalf. There are also qui tam provisions in 18 U.S.C. § 962 regarding arming vessels against friendly nations; 25 U.S.C.
What are typical False Claims Act cases?
Healthcare fraud, government contractor fraud, and environmental fraud are common types of False Claim Act cases. The False Claims Act allows individuals to report companies, federally funded programs, or individuals who commit fraud against the U.S. Government.
What are the three major categories of False Claim Act cases?
Liability under the federal False Claims Act occurs where a defendant (1) knowingly presents (or causes to be presented) a false or fraudulent claim for payment; (2) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim ; (3) conspires with others to ...
What happens if you make a false claim?
Violations under the federal False Claims Act can result in significant fines and penalties. ... A person who receives a benefit, by reason of fraud; makes a fraudulent statement ; or knowingly conceals a material fact is liable to the state for a civil penalty equal to the full amount received plus triple damages.
What happens if you file a false claim?
Defendants who are found to have violated the False Claims Act are required to pay the federal government three times the amount of damages sustained by the government and civil penalties of between $5,500 and $11,000 for each false or fraudulent claim.
What is prohibited under the False Claims Act?
The False Claims Act covers fraud involving any federally funded contract or program, with the exception of tax fraud . The two largest categories of federal funding programs represented in FCA actions are health care and defense industry fraud.
What percentage of False Claims Act cases are successful?
About 80 percent of all fraud cases won under the False Claims Act are a direct result of whistleblower lawsuits. Whistleblower awards under the Federal law have averaged 17% of recoveries. Whistleblowers usually compensate their attorneys by sharing the award.
How do I prove a false claim?
Material Requirements of a False Claim
To prove a case, the whistleblower must demonstrate not only that the representation about the claim is false , but also that the representation is material, which usually means related to the government’s decision to pay. Simply put the representation has to really matter.
What is considered an illegal provider relationship?
Which of the following is considered to be an illegal provider relationship? Any person or entity who knows, or should have known, of the presentation of a false or fraudulent claim to the government for payment or approval is subject to .
What is an example of a violation of the False Claims Act?
What Are the Most Common Examples of False Claims Act Violations? Most False Claims Act violations are in the healthcare and medical industries. Examples include people who lie to Medicare or Medicaid , facilities that bill for services they did not provide, or those that inflate the cost of the services they did get.
What does qui tam action mean in law?
Definition. In a qui tam action, a private party called a relator brings an action on the government’s behalf . ... For example, the federal False Claims Act authorizes qui tam actions against parties who have defrauded the federal government.
What is the whistleblower provision of the False Claims Act?
This important provision allows any individual or non-governmental organization to file a lawsuit, in U.S. District Courts, on behalf of the United States government. Under this provision, whistleblowers can be rewarded for confidentially disclosing fraud that results in a financial loss to the federal government .
