April 01, 2018

False Claims Act -- Investigative Tools of the Trade

Jeff Gibson, Bass, Berry & Sims, PLC, Nashville, TN and Greg Russo, Berkeley Research Group, Washington, DC

In the most general of terms, the False Claims Act (FCA), 31 U.S.C. §§ 3729-3733, imposes liability for any person or entity who knowingly submits a false claim to the federal government, knowingly makes a false record or statement to get a false claim paid by the government, or knowingly fails to repay an amount owed to the government.  FCA claims are often, but not always, initiated by a relator (also called a whistleblower), who files the claim under seal, prompting the government to investigate.  After its investigation, the government decides whether to intervene in the case or allow the relator to pursue the claims on its behalf.  As most in the healthcare industry already know, the government has been very aggressive, and very successful, in recent years in pursuing FCA liability against healthcare companies it believes have submitted false claims for reimbursement from Medicare, Medicaid, and other federal payors.  

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