March 01, 2015

False Claims Act Litigation under the Affordable Care Act

Since its enactment during the Civil War, the False Claims Act (FCA) has served as one of the government’s primary civil remedies for redressing false or fraudulent claims for funds allocated under federal health care programs (today most typically Medicare). In its simplest form, the FCA allows for an individual (known as a “relator”) to file suit on behalf of himself/herself and the United States. The cases are initially filed under seal while the government conducts its investigation of the alleged fraudulent activities and determines whether it will intervene on the relator’s behalf. Ultimately, if the government chooses to intervene on the relator’s behalf and proceeds successfully with the action, the relator can recover between 15 percent and 25 percent of any proceeds; if the government chooses not to proceed with the action but the relator decides to proceed independently, the relator can recover between 25 percent and 30 percent of the proceeds. 31 U.S.C. § 3730(d)(1)-(2).

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