Abstract
The False Claims Act (“FCA”) is a civil enforcement tool used to recover money improperly paid on fraudulent claims submitted to the United States. Although broadly applicable to any federal government payments, the majority of FCA recoveries by the federal government are in the healthcare industry. The FCA allows the government to recover payment and penalties from individual and businesses that “knowingly” submit false claims to the United States to obtain payments to which they are not entitled. The United States can recover three times the amount of money that was paid on the false claims, as well as penalties between $11,665 to $23,331 per false claim. Moreover, the FCA allows private citizens to bring “whistleblower” lawsuits against clinicians in the name of the United States. Frequently employees or former employees who believe they have seen inappropriate billing bring these cases to the attention of the government. Because either the government or a the whistleblower may take the case forward we refer to “plaintiff,” as opposed to government, when referring generally to the an entity bringing an FCA suit.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Fraud Statistic Overview, October 1, 1986 to September 30, 2020, United States Department of Justice, available at https://www.justice.gov/opa/press-release/file/1354316/download
31 U.S.C. § 3729
31 U.S.C. § 3731
United States v. Kellogg Brown & Root Servs., Inc., 800 F. Supp. 2d 143 (D.D.C. 2011)
United States v. Sci. Applications Int’l Corp., 626 F.3d 1257 (D.C. Cir. 2010)
Mikes v. Straus, 274 F.3d 687 (2d Cir. 2001), abrogated on other grounds by Universal Health Servs., Inc. v. U.S. ex rel. Escobar, 136 S. Ct. 1989 (2016))
Universal Health Servs., Inc. v. U.S. ex rel. Escobar, 136 S. Ct. 1989 (2016)
United States v. Krizek,111 F.3d 934 (D.C. Cir. 1997)
United States v. King-Vassel, 728 F.3d 707 (7th Cir. 2013)
Visiting Nurses Association of Brooklyn v. Thompson, 378 F.Supp.2d 75 (E.D.N.Y. 2004)
U.S. ex rel. Wuestenhoefer v. Jefferson, 105 F.Supp. 3d 641 (N.D. Miss. 2015)
United States v. Raymond & Whitcomb Co., 53 F.Supp. 2d 436 (S.D.N.Y 1999)
U.S. ex rel. Hunt v. Merck-Medco Managed Care LLC, 336 F.Supp. 2d 430 (E.D. Pa. 2004)
United States v. Molina Healthcare of Illinois, Inc., 17 F.4th 732 (7th Cir. 2021)
OIG Compliance Program for Individual and Small Group Physician Practices, Fed. Reg., Vol. 65. No. 194 at 59434 (October 5, 2000)
United States v. United Technologies Corp., 626 F.3d 313 (6th Cir. 2010)
U.S. ex rel. A+ Homecare, Inc. v. Medshares Management Group, Inc., 400 F.3d 428 (6th Cir. 2005) superseded by statute as stated in U.S. ex rel. Harper v. Muskingum Watershed Conservancy Dist., 842 F.3d 430 (6th Cir. 2016)
United States v. Rogan, 517 F.3d 449 (7th Cir. 2008)
U.S. Dept. of Justice, United States Resolves $237 Million False Claims Act Judgment against South Carolina Hospital that Made Illegal Payments to Referring Physicians (Oct. 16, 2015), https://www.justice.gov/opa/pr/united-states-resolves-237-million-false-claims-act-judgment-against-south-carolina-hospital
31 U.S.C. § 3730
U.S. Dept. of Justice, Fraud Statistic Overview, October 1, 1986 to September 30, 2020, available at https://www.justice.gov/opa/press-release/file/1354316/download
Ruckh v. Salus Rehab., LLC, 963 F.3d 1089 (11th Cir. 2020)
U.S. Dept. of Justice, M.D. Granston, Factors for Evaluating Dismissal Pursuant to 31 U.S.C. 3730(c)(2)(A) (Jan. 10, 2018)
Reuters, A. Frankel, DOJ doubles down in brief to discredit ‘Wall Street-backed’ False Claims Act whistleblower (Feb. 25, 2019), https://www.reuters.com/article/us-otc-fca/doj-doubles-down-in-brief-to-discredit-wall-street-backed-false-claims-act-whistleblower-idUSKCN1QE2IX
Chuck Grassley News Releases, Senators Introduce Bipartisan Legislation To Fight Government Waste, Fraud (Jul. 26, 2021), https://www.grassley.senate.gov/news/news-releases/senators-introduce-of-bipartisan-legislation-to-fight-government-waste-fraud
Swift v. United States, 318 F.3d 250 (D.C. Cir. 2003)
Sequoia Orange Co. v. Baird-Neece Packaging Corp., 151 F.3d 1139 (9th Cir. 1998)
United States v. UCB, Inc., 970 F.3d 835 (7th Cir. 2020), cert. denied sub nom. Cimznhca, LLC v. United States, 2021 WL 2637991 (U.S. June 28, 2021)
U.S. ex rel. Borzilleri v. AbbVie, Inc., 837 F. App’x 813 (2d Cir. 2020)
United States v. Eli Lilly & Co., Inc., 4 F.4th 255 (5th Cir. 2021)
Erickson v. Biogen, Inc., No. C18-1029-JCC, 2020 WL 885743 (W.D. Wash. Feb. 24, 2020)
U.S. ex rel. Grant v. United Airlines Inc., 912 F.3d 190 (4th Cir. 2018)
U.S. ex rel. Shea v. Verizon Communications, Inc., 844 F.Supp.2d 78 (D.C.D. 2012)
U.S. ex rel. Doghramji v. Cmty. Health Sys., Inc., No. 3:11 C 442, 2019 WL 4887190 (M.D. Tenn. Oct. 2, 2019)
United States v. AseraCare, Inc., 938 F.3d 1278 (11th Cir. 2019)
U.S. ex rel. Druding v. Care Alternatives, 952 F.3d 89 (3rd Cir. 2020)
U.S. ex rel. Winter v. Gardens Reg’l Hosp. & Med. Ctr., Inc., 953 F.3d 1108 (9th Cir. 2020)
U.S. Department of Justice, Healthcare Service Provider to Pay $60 million to Settle Medicare and Medicaid False Claims Act Allegations, https://www.justice.gov/opa/pr/healthcare-service-provider-pay-60-million-settle-medicare-and-medicaid-false-claims-act (Feb. 6, 2017)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Ferry, J.H., Medlin, L.E. (2022). The False Claims Act. In: Pasha, A.S. (eds) Laws of Medicine . Springer, Cham. https://doi.org/10.1007/978-3-031-08162-0_17
Download citation
DOI: https://doi.org/10.1007/978-3-031-08162-0_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-08161-3
Online ISBN: 978-3-031-08162-0
eBook Packages: Law and CriminologyLaw and Criminology (R0)