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Reducing the risk of False Claims Act qui tam actions

Health Care Compliance Association

Compliance Today

June 2017

Authors: Joan W. Feldman

Under the Federal False Claims Act (FCA), the presentation of a false claim for payment to the federal government can result in significant liability for providers participating in government-payer programs such as Medicare or Medicaid. Liability for false claims submitted to a state’s Medicaid program can also result in false claims liability pursuant to state or federal law.

Liability typically arises one of two ways: (1) the government itself brings an FCA action against the provider; or (2) a private individual(s) brings an FCA action (known as a qui tam or whistleblower claim) against a provider on behalf of the government.1 In the event that the government pursues an FCA qui tam action brought by a whistleblower, the individual claimant gets to share between 15% and 25% of the government’s recovery.2 Given the financial incentives to share in the government’s recovery, it should come as no surprise that the number of FCA qui tam actions being brought against healthcare providers is on the rise.3,4

Read the full article here.

Reproduced with permission from the June 2017 issue of Compliance Today. Copyright © 2017, Health Care Compliance Association.

1. See 31 U.S.C. § 3730.
2. See 31 U.S.C. § 3730(d).
3. U.S. Department of Justice, Office of Public Affairs press release: “Justice Department Recovers Over $4.7 Billion from False Claims Act Cases in Fiscal Year 2016” December 14, 2016. Available at http://bit.ly/2pIjnmb.
4. U.S. Department of Justice, Civil Division: “Fraud Statistics – Overview, October 1, 1987 - September 30, 2016” December 13, 2016. Available at http://bit.ly/2pHNIOP.

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