WHAT IS THE FALSE CLAIMS ACT?

The False Claims Act, or Qui Tam Law, is designed to encourage citizens to expose fraud by accoding people a percentage of any damage award that is collected.

The Qui Tam laws were first passed in 1863, during the American Civil War, and they were prompted after sensational testimony was presented to Congress. That testimony was about some exhorbitant costs being charged to the government for goods and services. Some of the goods or services were never even delivered! Other goods and services were sub-standard.

THE CAPITOL OF THE UNITED STATES, CIRCA 1863

In the late 1930's, a number of “parasitical suits” were filed in which the relator sued based on information that was copied from government files and indictments. These "parasitical suits" continued to be brought by trains of individuals who had contributed nothing to the discovery of the fraud in an alleged case.

Congress amended the False Claims Act in 1943. The 1943 amendments severely restricted the number of potential qui tam actions filed by private citizens or relators. These amendments effectively prohibited government employees from bringing suit under the False Claims Act.

Recognizing the need to increase government and private efforts to stop fraud, Congress liberalized some of the Act's provisions in 1986. The 1986 amendments grant any private “person” the right to bring a civil action under the Act, subject to four specific exceptions set forth in the code. The end result of the 1986 amendments was the creation of a more relator-friendly False Claims Act that is in effect today.

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WHAT IS MEDICARE FRAUD?

Are healthcare regulations being complied with at your office? Are your office's healthcare practices and procedures different than those required by healthcare regulations? Are two sets of patient records being maintained in separate locations?

A Medicare or other healthcare fraud case may surface from information given by a disgruntled employee in an employment action. For instance, a healthcare provider may coerce an employee to do some act that the employee knows is unethical, wrong, fraudulent, or criminal, related to Medicare or Medicaid billing, reporting, or cost accounting. When the employee refuses to cooperate, they may be labeled a trouble-maker and fired.

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