False Claims FAQ, Part One: Coverage and the Qui Tam Provision

On a regular basis, we use this blog to discuss health care fraud, government contracts fraud, and a range of related issues that fall under the False Claims Act and similar pieces of legislation.  In a two-part post, our government fraud whistleblower’s law firm is taking a step back to provide a broader look at this important law.  Part One provides a general overview of the law and what it covers while Part Two (to be published in coming weeks) will look at how a suit unfolds and the importance of engaging a knowledgeable False Claims Act lawyer.

In brief, the FCA is a federal law that provides remedies when an individual or entity files a fraudulent bill (the “claim”) with the federal government or one of its agencies. The FCA is not a “gotcha” statute and it does not apply in cases of genuine mistake.  To be covered by the Act, the claim must be made knowingly and with deliberate ignorance or willful disregard for its false nature.  While the FCA only applies to fraud on the federal government, many states have similar laws applicable to fraud on the state government.

  • What types of claims may violate the FCA?

Claims that may trigger FCA liability include: A bill that does not comply with the law (e.g., asking for payment on a service that doesn’t comply with Medicare rules); A bill that over-represents the amount or quality of a product (e.g., a defense contractor supplying goods that do not meet contractual standards); or A bill that understates monies owed to the government.  Mortgage fraud, Medicare (or other federal health program) fraud, and defense contracting fraud are among the most common topics for an FCA suit, but the Act applies in many other contexts.  Tax matters are not covered by the FCA.

  • What is a qui tam lawsuit?

A qui tam lawsuit is a claim filed by a private party on behalf of the government.  The person who files a qui tam claim is called the “realtor” or, more informally, the “whistleblower.”  There can be more than one realtor in a given suit.  The FCA’s qui tam provision is discussed at length in The False Claims Act: A Primer, authored by the Department of Justice.

Generally, qui tam cases must be filed within 6 years from the fraud or 3 years from when the government should have known about the fraud, but not more than 10 years from when the fraud occurred.  If the same fraud is the topic of an existing FCA suit, a new claim may be barred due to a “first to file” rule.  Likewise, a qui tam claim can be barred if the information on which it is based is already public (e.g., disclosed in the news or via another government hearing) unless it was the realtor who made it public.  These rules are among the reasons why it is important to file in a timely manner and why a potential realtor should not discuss the issues with anyone other than his/her attorney.

Our Whistleblowers’ Law Firm

Part Two of this FAQ will be published in the coming weeks (we will provide a link after that post goes live).  In the meantime, if you have knowledge of a claim that may violate the FCA, please call our government fraud whistleblower’s lawyer to discuss the law and how you can become part of the fight against fraud.

(edited to add a link to False Claim FAQ, Part Two: The Importance of Whistleblowers and Our Whistleblowers’ Law Firm)

See Related Blog Posts:

The Many Uses of the False Claims Act: Beyond Medicare Fraud and Military Contracts

The False Claims Act and the Role of Whistleblowers in Stopping Health Care Fraud


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