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healthcare defense false claims act qui tam defense lawyers

June 30, 2020

In a bid to curb the increasing number of fraud cases against the government, Congress formulated and passed a bill that introduced incentives for people who report anyone engaging in fraudulent activities against the government.

The False Claim Act (FCA) was signed into law on March 2, 1963 by President Lincoln.

Also referred to as the Informer’s Act, the Initial False Claims Act barred against several acts meant to fraudulently acquire money from the government.

Initially, Congress passed the FCA with the intention of curbing fraudulent activities against the United States Army during the Civil War.

Despite the fact that earlier legislation of the act primarily focused on fraudulent activities in the Military, the Act was also as applied to all contractors who dealt with the government.

The term “qui tam” is a Latin expression that literally means “the one who sues on behalf of the king as well as for himself”. The act was to encourage the public to report fraudulent activities against the government.

The FCA act has undergone several changes in congress. The most significant change took place in 1986 when it was amended to reward insider whistle-blowers as well as avoid opportunistic plaintiffs.

Despite the changes introduced to the FCA, there are many fraudulent cases are still being reported. The federal government together with state governments have been working together to find ways of sealing loopholes that aid fraudulent activities in different sectors.

Below are some of the changes that have been made to the False Claims Act:

• The 2009 Fraud Enforcement Act
• Mandatory disclosure placed under the Federal Acquisition Regulation (FAR)
• Recent decisions of the court on healthcare fraud cases
• Debarment risk and debarment
• Incentives for whistle-blowers

Types of claims under the False Claims Act

In 1986 the United States congress broadened the judicial interpretation of the term “claim” to include the following:

• A false claim involving the deliberate representation of false information that results in the government making higher payments for service than the amount required.
• For instance, a doctor will be deemed guilty if it is proved that he submitted payment claims of surgery he or she didn’t perform. In this case, the government will demand reimbursement for each false claim presented by the physician.
• False certification involving a defendant who knowingly certifies compliance with mandatory provisions of a contract, regulation, governmental program, or statute.
• When an individual colludes with an insurance company to seek free services from the government based on a stage-managed accident.
• Filing for claims for services not included on an insurance cover

How does one file a qui tam suit?

One of the most important things when it comes to filing a qui tam whistle-blower lawsuit is a disclosure statement under the False Claims Act. The act states that a qui tam whistle-blower must provide a written document providing all available evidence with regard to the alleged healthcare fraud.

The main purpose of the disclosure statement is to give government officials an opportunity to investigate the alleged fraud and determine if it is worth launching formal charges against the perpetrator.

Nonetheless, the act is not clear as to the specific information that should be included in a disclosure statement. It is important to seek help from an experienced defense criminal lawyer to assist you in determining what to include and not to.

Filing a lawsuit under the FCA

Requirements for a seal while filing a qui tam lawsuit were introduced in 1986. Although the main intention of Congress was to make FCA lawsuits private, there was a general concern that false claim suits could forewarn victims of the impending investigations. Consequently, a 60-day seal window was introduced by Congress to take action.

The seal period is to allow the government to conduct an undercover investigation and determine if the false claims allegations are legitimate or not. The federal government can also ask for more seal days if it feels that those 60 days are not sufficient to acquire crucial evidence.

In a nutshell, the False Claims Act was enacted to curb healthcare fraud cases in the United States. Although the act has played a significant role in reducing fraud in the healthcare sector, there are many cases that are still being reported.

It is always important to ensure that you hire the services of an experienced criminal defense lawyer – in case you are involved in an FCA lawsuit.



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