The False Claims Act (FCA) is a federal law which prohibits parties from asserting false statements in claims to the United States government for the purposes of obtaining money or reimbursement to which they are not entitled.
The FCA is an important “whistleblower” law against government fraud. The Act includes a “qui tam” provision, allowing private citizens not affiliated with the government to file actions on behalf of the government and potentially receive 30% of any recovered damages.
FCA claims often involve health care and pharmaceuticals, disaster relief, education, as well as government loans and benefits.
Healthcare & Pharmaceuticals
Healthcare and pharmaceutical false claims typically arise within the context of Medicare/Medicaid fraud. False claims are not claims with mere errors or innocent billing mistakes. Providers know these claims are fraudulent.
Healthcare false claims often involve allegations of total neglect or no services rendered, worthless services rendered, inadequate or inferior services and products, or unnecessary patient treatment.
Other types of healthcare fraud may include misrepresentation of credentials, upcoding or unbundling of services, or misrepresentation relating to patient data.
Pharmaceutical false claims involve fraud, depriving the government of money which pharmaceutical companies are required to reimburse under the United States Medicare Rebate Program. These types of false claims usually involve off-label marketing or promotion, best price or nominal price fraud and pharmaceutical kickbacks.
Federal and State governments spend billions of dollars in response to natural disasters such as hurricanes, floods, tornados, earthquakes, and fires. These funds are used for a wide variety of services to the public including immediate and long term housing assistance, immediate and long term public assistance, Community Disaster Loans, Community Development Block Grants, repairs to infrastructure such as roads and bridges, in addition to loans for small business owners.
Unfortunately, there has been an epidemic of disaster relief fraud on the part of businesses and individuals contracted to provide these disaster relief products and services. Some of these disaster relief false claims involve allegations of services not performed, products never used, overpricing, double billing and services provided by ineligible or unlicensed contractors.
Every year, the United States Department of Education provides billions of dollars in loans, work-study programs and grants to educational institutions and students across the nation.
Education false claims often involve overcharging for books sold to schools, libraries, and government agencies; fraud related to research grants and contracts; private education consultant fraud; and higher education recruiting, financial aid, and placement fraud.
Another type of false claim in education involves E-Rate Program fraud. The E-Rate Program subsidizes educational computer technology for school children living in economically disadvantaged and rural areas and is funded through federal tax dollars collected from telephone customers across the nation on their monthly bills.
E-Rate fraud occurs when the contracting company charges the government for ineligible and/or nonexistent technology upgrade projects, projects which were never initiated or completed or overcharges or mischarges for services rendered.
Eligibility for Loans/Benefits
There are a variety of government loan and benefit programs offered to qualifying individuals and businesses. Some examples of government-issued loans include Housing and Urban Development (HUD) mortgage loans, Veteran’s Administration (VA) home loans, Federal student loans, Small business loans and Farm operating loans. Government benefits may include retirement or disability benefits disbursed by the Social Security Administration.
False claims of eligibility for a loan under a government funded program involve any false statement on the loan application or a misrepresentation of need in order to qualify for the loan.
False claims of eligibility for Social Security Disability Benefits may involve concealing work in order to continually receive disability benefits, exaggerating claims, deliberately causing accidents, or concealing material information that affects disability claims.
The federal government allots billions of tax dollars to contractors for the construction of public works. Public works is a broad term which includes a wide variety of projects including federal and other public buildings such as schools and hospitals; transport infrastructure such as roads, railroads, bridges, pipelines, canals, ports and airports; public squares, parks and beaches; and public services such as water supply, sewage, and electrical grids.
False claims by contractors related to public works often involve bid-rigging, overcharging for contracts, billing for work not performed, falsifying material costs, falsifying test results and/or progress reports.
Other types of public works fraud may include using substandard materials, or unqualified personnel, failing to follow project specifications, violating buy American requirements, falsifying minority contractor status, and distributing or accepting bribes and kickbacks.
Filing a Lawsuit
False Claims Act complaints are filed in the US District Court. After that, the government conducts a confidential investigation that the accused is not aware of while the investigators search the facts. After the investigation phase, the government may decide to move forward in prosecuting the case.
The statute of limitations to file a False Claims Act lawsuit is six years from the date the government paid the fraudulent claim. However, certain types of fraud have different statute of limitations, so its best to do your research and not delay in filing suit.
The information on this website is intended as general legal information only and should not form the basis of legal advice of any kind. Individuals seeking specific legal advice should consult a lawyer.