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Healthcare defense overview false claims act whistleblower qui tam defense lawyers

July 2, 2020

Congress enacted the False Claims Act (FCA) in 1863. When Congress created this act, they were concerned that suppliers of goods were defrauding the Union Army during the Civil War.

As a result, the FCA enforced that submitting false claims to the government can lead to double the government’s damages and penalties for each false claim. Over time, the False Claims Act has been amended.

The False Claims Act

Any individual or business that contracts with and is paid by the government falls under the False Claims Act. The business dealings can be direct or indirect. What the FCA does is creates liability against contractors that consciously submits false claims with intentions of receiving payment.

Failing to conduct due diligence and submitting an inaccurate claim, goes against the FCA. Even if someone claims to “not know” they can still be penalized if they “should have known” about a false claim.

What Are The False Claims Penalties?

Before penalties can be enforced, an investigation must occur. False claims investigations are challenging. Civil and criminal penalties can apply to a False Claims Act offense. Often, at the beginning of an FCA case, it is hard to determine whether criminal or civil charges should be filed.

Civil penalties for FCA crimes include:
• A penalty of up to $11,000 per claim and triple damages

Criminal penalties for FCA crimes include:
• Up to 5-years in prison
• $250,000 fine (individuals) or $500,000 fine (companies) for each federal conviction
• $100,000 fine (individual) or $200,000 (companies) fine for misdemeanor conviction

Qui Tam Lawsuit

The majority of FCA investigations are initiated by former employees or competitors of the accused individual/company. Qui Tam is a Latin expression that means “he who sues for the king and himself.” There is a provision in the FCA that permits private citizens to issue a qui tam lawsuit.

A qui tam lawsuit can recover money on behalf of the U.S. government. In this case, the person or business that reports the fraudulent acts is classified as a “whistleblower.” A whistleblower is a person that exposes secretive and unlawful activity or information within an organization. The information divulged is deemed unethical, illegal, or corrupt.

Qui Tam Plaintiff

A qui tam plaintiff or sometimes referred to as the relator files a complaint in federal court. The plaintiff can file a complaint against a business, an individual, or both. In a qui tam lawsuit, the plaintiff’s identity is hidden. To help secure the identity of the plaintiff, the lawsuit is filed under seal.

Only the judge and certain government officials can have access to the complaint. Six-month extensions can be granted to keep the case sealed for protection. The extensions can continue until the government has the opportunity to investigate the complaint.

Quit Tam Lawsuit Evidence

Any unsubstantiated complaints are immediately rejected by the U.S. government. The government. The complaint has to have facts and evidence for the U.S. government to take it seriously.

If the government feels a complaint is promising, they may agree to an investigation. Typically, the U.S. government will receive help from the U.S. Attorney’s Office, FBI, and DEA to help investigate the case.

In a qui tam lawsuit, the accused party has to produce corporate, billing, financial, and other business records as evidence. The documentation is enforced by OIG subpoenas.

Government Intervention & Qui Tam Lawsuits

After the review of the subpoena documentation and healthcare defense attorney negotiations, the government will intervene. At this moment, the U.S. government has to decide on whether they will support the plaintiff.

The Department of Justice (DOJ) has to approve the government’s intervention in a qui tam lawsuit. If approved, the DOJ can amend the complaint to include the causes of the illegal actions, which include additional legal charges. The additional legal charges can include violations of the Truth in Negotiations Act and the Anti-Kickback Act.

False Claim Act Attorneys

Experienced FCA attorneys are specialized to provide a defense against FCA and qui tam lawsuits. Typically, negotiations between the U.S. government and the defendant’s lawyers take place to figure out a case settlement. It can take months before a case is resolved.

If found liable, charges and penalties are enforced. Qui tam plaintiffs are usually incentivized with being able to keep up to 25% of the collected money.

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