Common False Claims

False claims are created anytime the government is damaged by misrepresentations or falsehoods. Anytime that happens it could constitute a case on the False Claims Act. If you are interested in filing for any of the common false claims listed, contacting a distinguished False Claims Act attorney may be critical to your case. Such common false claims include:

Overbilling, double billing, upcoding, billing for services that are not provided, not providing services and claiming that somebody did, providing material that is worthless. These are just the most obvious and general categories of false claims provided or the false claims made against the United States which are actionable under the law.

Defining the False Claims Act

The federal False Claims Act includes several different kinds of common provisions to create liability, including provisions for submitting a false claim. It can include provisions in regards to:

  • Creating a false statement in order to get a claim paid
  • Conspiracy
  • Reverse false claims: when a company is holding on to property or money belonging to or owed the government

Any of these types of liability are subject to the same damage provisions that allow the government to collect three times the amount of damages that it suffers as a result of any fraud committed against the U.S.

Recent Amendments

There have been recent changes in the way common false claims are handled under the law. For example, The government now has the authority to waive the restriction on the right of a person to file a case under the False Claims Act when there has been a public disclosure. The Law’s success has led to additional whistleblower acts. The federal False Claims Act is the model for whistleblower laws generally and for state False Claims Acts.

Now there are at least 30 False Claims Act and local statutes throughout the states in the United States. In some states the False Claims Act is restricted to healthcare programs, some state acts are restricted only to recovering state funds. Other state acts are not restricted to specific programs, and several allow an individual to sue if a county or a political subdivision, for example, has been the subject of the fraud.

The state Acts can generally be filed in their own courts, but commonly, a nationwide scheme may be alleged in which both federal and state money is at stake. When this happens, the federal False Claims Act provides jurisdiction over state and federal law claims, so it is possible to file multiple actions at once under the federal False Claims Act.

Restrictions and Public Records

The False Claims Act has certain restrictions on who may file successfully and maintain an action. No action is possible if the government has already proceeded with the same facts in the civil court, and no action will be maintained if the government is already proceeding on any monetary penalty. There is also a public disclosure bar.

The public disclosure bar was amended in 2010 as part of the Affordable Care Act so that it is not the complete restriction it once was regarding individuals filing cases. Under the public disclosure bar, the facts can be well-known, either through the press or presentations in legislative hearings.

One can file a case if it can be established that the whistleblower is an original source of the information, which usually means having independent knowledge of that information and providing that knowledge to the government prior to filing a case in court. An original source can go forward with the case.

False Claims Cases

False claims cases include everything from selling drugs, for off-label uses (meaning uses, which are not approved by the FDA) and or lying about their efficacy to get them approved, or marketing through kickbacks by anyone who provides medical services, as well as faulty equipment sold to defense contractors. All of these areas have created cases, which involve False Claims Act allegations. Even within defense contracting and healthcare, there are specific kinds of cases and violations, which have created new and different subcategories of false claims.

Fraud Laws

Understanding common false claims requires an understanding of fraud laws and on what the government spends money. Medicare funds are a huge portion of the federal budget meaning there are different kinds of services and products provided by medical providers. These providers include pharmaceutical companies and medical device manufacturers. When those entities as with any provider engage in fraud, it can create False Claims Act violations. In this regard, two more laws worth knowing about are the Stark anti-self-referral law and the Anti-Kickback Statute.

Both of these laws create liability when somebody engages in kickbacks in the medical field. It is illegal to incentivize medical care and have people pushed to one medical provider or another if that provider is charging government programs for the service.

Both the Stark law and the Anti-Kickback Statute confer automatic False Claims Act liability if they are violated. The False Claims Act itself is extremely powerful as it allows for treble (three times) damages. Three times the amount of damages assessed is what the defendant would be liable to pay in court.

Civil Fines

Civil fines are potentially available and they rise as a result of legislation that requires those fines to increase with inflation. They can be assessed for each and every violation of the False Claims Act. While civil damages are not always applied in common false claims settlements involving large amounts of damages, they do increase the potential liability for defendants and they do create additional exposure for them.

Rewarding Whistleblowers

The rewards to the relator, which is the name used to discuss an individual whistleblower or plaintiff under the False Claims Act, are meant to be considerable. A plaintiff-relator is in a position to obtain between 15 to 30 percent of any governmental collection depending on how the action proceeds. If the government intervenes and takes over the case, the private party relator can obtain 15 to 25 percent of a collection.

If the government does not take over the case but the individual plaintiff-relator decides to go forward with the case on their own then the range is from 25 to 30 percent. In common false claims cases, there are Acts in many states which are modeled on the federal False Claims Act. Some of those states have higher individual reward provisions than the federal law.