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What Conduct Constitutes a False Claim?

On Behalf of | Oct 19, 2018 | Firm News

More often than not, our clients come to us unaware that they have a potential whistleblower action under the False Claims Act.  They are aware that their employer is engaging in practices that make them uncomfortable. Some times the conduct is blatant, some times more subtle.  Frequently, when our client speaks out against the practice, the fraudster employer terminates them.  The clients first approach us seeking help for the wrongful termination.

So what constitutes an actionable claim under the False Claims Act?  Put simply, any time the fraudster submits a claim to any government entity for money (for example, an invoice, a charge to Medicare or Medicaid, a draw on a grant) where the services were not performed, or when a fraudster fails to pay taxes owed, or fails to repay money where the government entity overpaid, then that submission is a false claim.  Similarly, where a medical professional gets a kickback for using certain drugs or certain services, that too constitutes a violation of the False Claims Act.

A clear example of fraud is when a doctor bills Medicare or Medicaid or Tricare for services or procedures he or she did not perform. This may come to our client’s attention because the physician is billing Medicare for 20 hours of office visits a day, when such volume is not possible.  Alternatively, a physician may be billing for procedures he is not performing, upcoding the procedures he is performing to a more lucrative procedure, or worse yet, billing for performing procedures on patients who do not need the procedure.  The most startling example of the latter point is where an oncologist informed his healthy patients that they had cancer, and treated them for the non-existent cancer.  The U.S. Attorneys’ Offices take these healthcare fraud matters very, very seriously, particularly in the instance of patient harm.

To see the type of cases we’ve handled, please review our “case results” page.

The False Claims Act also provides protections for whistleblowers.  An employer cannot retaliate against you in any manner for reporting fraud.  In other words, you cannot be terminated, demoted, docked pay or other such conduct because you reported the fraud to your supervisor or employer.

We’d love to discuss your potential case with you, so please contact us.