False Claims Act

Phoenix False Claims Act Lawyer

The False Claims Act (FCA), also called the “Lincoln Law“, is a federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. It is the federal Government’s primary litigation tool in combating fraud against the Government. The law includes a qui tam provision that allows people who are not affiliated with the government, called “relators” under the law, to file actions on behalf of the government (informally called “whistleblowing” especially when the relator is employed by the organization accused in the suit).

The statute begins, in § 3729(a), by explaining the conduct that creates FCA liability. In very general terms, §§ 3729(a)(1)(A) and (B) set forth FCA liability for any person who knowingly submits a false claim to the government or causes another to submit a false claim to the government or knowingly makes a false record or statement to get a false claim paid by the  government. Section 3729(a)(1)(G) is known as the reverse false claims section; it provides liability where one acts improperly – not to get money from the government, but to avoid having to pay money to the government. Section 3729(a)(1)(C) creates liability for those who conspire to violate the FCA. Sections 3729(a)(1)(D), (E), and (F) are rarely invoked.

A person does not violate the False Claims Act by submitting a false claim to the government; to violate the FCA a person must have submitted, or caused the submission of, the false claim (or made a false statement or record) with knowledge of the falsity. In § 3729(b)(1), knowledge of false information is defined as being (1) actual knowledge, (2) deliberate ignorance of the truth or falsity of the information, or (3) reckless disregard of the truth or falsity of the information.

Doctor’s Beware 

Recent federal case law appears to require physicians, hospitals and medical professionals to know the legal requirements for the valid submission and collection of claims for medical services. Medical professionals who simply chose not to educate themselves may be found to have acted in deliberate ignorance or with reckless disregard and may thereby be liable under the False Claims Act. The submission of a Medicare claim by a provider is a certification that the provider has complied with the Medicare Act’s medical necessity definitions and complied with all relevant laws regarding submission of claims to the federal government.

Common False Claims And Statements

Many false claims and statements involve the Medicare and Medicaid systems or any other government agency that provides some sort of benefit. Here are some examples of how false claims and statements are used to defraud certain entities:

  • An individual submits an application for Medicaid and they do not fully state their income or they claim more children than they have or provide some other form of false information in order to receive benefits.
  • A medical facility submits a false claim to Medicare or Medicaid in order to get payment for services that were never provided. This is a crime that may be accompanied by other charges if charges are filed.
  • An individual fakes a mental illness or other condition in order to receive SSI or Social Security benefits. In reality, the individual is able-bodied although they do not represent themselves as such.
  •  A person applies for Welfare benefits when they don’t need them. They may state that they cannot work when they really can.

Because of the fact the state Medicaid system can be affected, Arizona has considered legislation that would give it its own False Claims Act so it can recover the civil penalties for false claims that are received by the state government.

Arizona Federal Criminal Defense

Because Arizona does not yet have its own False Claims Act, the federal court system takes over. Myles A. Schneider has won cases in federal court in which the prosecution had evidence to present. However, the prosecution’s evidence has to be strong enough to support their claims. If a person can admit they are disabled or a doctor can show that a medical procedure was completed, then the charges can be dropped. And while there are legitimate cases, it doesn’t mean there is no hope for a better outcome than the maximum penalties if a conviction occurs.

Contact An Arizona False Claims And Statements Attorney

Even if you think you deserve to pay the maximum penalties for false claims and statements, that doesn’t mean you should or will. People make mistakes. Bad judgment and even desperation can lead to people doing things they would not normally do. That does not mean that the consequences have to be the harshest possible. Myles A. Schneider will fight for you to help you have a chance toward living your life again. Call us today at 602-926-7373 to schedule your free consultation.