False Claims Act Defense

Defense against False Claims Act violations, qui tam whistleblower actions and parallel
criminal fraud charges in Arizona.

Myles A. Schneider

30+ Years Federal Defense

Facing False Claims Act Charges? We Can Help.

A former employee or business partner filed a qui tam lawsuit and now the federal government has joined the case against you. False Claims Act cases are devastating because the financial exposure is enormous. The government can seek triple damages plus penalties of over $11,000 per false claim submitted. If you had a government contract and someone alleges you overbilled or didn’t deliver what you promised your entire business is at stake.

I defend companies and individuals against False Claims Act allegations. I know how to challenge the relator’s credibility and I know how to negotiate with DOJ attorneys to minimize your exposure. These cases often settle but only if you have aggressive representation pushing back.

Federal Statute Details: Elements of the False Claims Act

The False Claims Act imposes liability on any person who knowingly submits, or causes to be submitted, a false or fraudulent claim to the federal government. While the FCA is primarily known for its civil provisions, which allow for treble damages and significant per-claim penalties, the federal government frequently pursues parallel criminal proceedings under 18 U.S.C. § 287 (Criminal False Claims) and 18 U.S.C. § 1347 (Health Care Fraud), among other statutes.

Under 31 U.S.C. § 3729(a)(1), liability attaches to any person who:

Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

Knowingly makes, uses or causes to be made or used, a false record or statement material to a false or fraudulent claim;

Conspires to commit a violation of the FCA; or

Knowingly makes, uses or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government (known as a “reverse false claim”).

**The Knowledge Requirement (Scienter)** A critical element of the FCA is the “knowing” requirement. The statute defines “knowing” and “knowingly” to mean that a person:

Has actual knowledge of the information;

 

Sentencing Guidelines and Mandatory Minimums

In federal criminal cases, judges are required to consult the United States Sentencing Guidelines (U.S.S.G.) when determining an appropriate sentence. While the Guidelines are advisory following the Supreme Court’s decision in *United States v. Booker*, they remain the starting point and anchor for all federal sentencings.

Criminal convictions related to false claims are typically sentenced under U.S.S.G. § 2B1.1, which governs offenses involving fraud and deceit.

The **Base Offense Level** for most fraud offenses under § 2B1.1 is 6 (or 7 if the statutory maximum term of imprisonment is 20 years or more).

The most significant driver of the final offense level is the **Loss Amount** under § 2B1.1(b)(1). The Guidelines dictate substantial increases to the offense level based on the financial loss suffered by the government. For example, a loss of more than $150,000 adds 10 levels, while a loss exceeding $1.5 million adds 16 levels. The court will consider both the “actual loss” (the amount actually paid out by the government) and the “intended loss” (the amount the defendant sought to obtain), using whichever is greater.

Several specific offense characteristics can further increase the defendant’s sentencing exposure:

Number of Victims: If the offense involved 10 or more victims, or was committed through mass-marketing, the offense level increases by 2. (In FCA cases, the primary victim is the government, but secondary victims may exist).
Sophisticated Means: If the offense involved sophisticated means (e.g., complex corporate shells, offshore accounts, or intricate billing software manipulation), the offense level increases by 2.
Abuse of Position of Trust: Under U.S.S.G. § 3B1.3, if the defendant abused a position of public or private trust, or used a special skill, in a manner that significantly facilitated the commission or concealment of the offense, the offense level increases by 2. This enhancement is frequently applied to physicians, corporate executives, and licensed professionals.
 

DOJ Enforcement Trends and Priorities

The Department of Justice has consistently prioritized the enforcement of the False Claims Act, viewing it as the most effective weapon against corporate fraud. In recent fiscal years, the DOJ has recovered billions of dollars annually through FCA settlements and judgments, with a significant portion stemming from the healthcare and defense procurement sectors [2].

Healthcare Fraud and the Opioid Epidemic: The DOJ continues to aggressively target healthcare providers, pharmaceutical companies, and pharmacies involved in illegal kickbacks, medically unnecessary services, and the over-prescription of opioids. The Medicare Fraud Strike Force operates in key regions to identify and prosecute coordinated schemes.
Cybersecurity Fraud: The DOJ’s Civil Cyber-Fraud Initiative utilizes the FCA to pursue government contractors and grant recipients who fail to comply with required cybersecurity standards, misrepresent their cybersecurity practices, or fail to report breaches.
Pandemic Relief Fraud: The DOJ remains focused on prosecuting individuals and businesses that defrauded COVID-19 relief programs, such as the Paycheck Protection Program (PPP) and the Provider Relief Fund.
Private Equity and Corporate Accountability: The DOJ has increased its scrutiny of private equity firms that invest in healthcare companies, holding them accountable when they direct or encourage portfolio companies to engage in aggressive billing practices that violate the FCA.

The DOJ frequently utilizes data analytics to identify anomalous billing patterns, allowing investigators to target providers whose claims significantly deviate from their peers.

 

District of Arizona Specifics

The United States Attorney’s Office for the District of Arizona (USAO-AZ), which operates divisions in Phoenix and Tucson, is highly active in prosecuting federal fraud cases. The District of Arizona presents unique enforcement dynamics due to its large healthcare sector, significant defense contracting presence, and proximity to the border.

Healthcare Fraud Task Forces: The USAO-AZ collaborates closely with the HHS Office of Inspector General (HHS-OIG) and the FBI to target Medicare and Medicaid fraud, particularly involving behavioral health facilities, sober living homes, and telemedicine schemes. Arizona has seen a surge in prosecutions related to fraudulent billing for substance abuse treatment and wound care [3].
Defense Procurement: With major military installations and defense contractors located in Arizona, the USAO-AZ actively investigates allegations of defective pricing, cross-charging, and the provision of substandard parts to the Department of Defense.
Parallel Proceedings: The District of Arizona frequently employs parallel proceedings, where civil FCA investigations and criminal fraud investigations are conducted simultaneously. This coordinated approach allows the government to leverage civil discovery tools to build a criminal case, making early defense intervention critical.
 

The Investigation Process

Federal investigations into False Claims Act violations are typically exhaustive, resource-intensive, and highly secretive in their early stages.

Investigations are most commonly triggered by:

Qui Tam Whistleblowers: The FCA contains a *qui tam* provision that allows private citizens (relators)—often current or former employees—to file lawsuits on behalf of the government. These complaints are filed under seal, giving the DOJ time to investigate the allegations before the defendant is even aware of the lawsuit.
Data Mining: Federal agencies use sophisticated algorithms to flag unusual billing codes, high volumes of specific procedures, or statistical outliers.
Audits and Referrals: Routine audits by Medicare Administrative Contractors (MACs) or the Defense Contract Audit Agency (DCAA) can lead to referrals to federal law enforcement if fraud is suspected.

Investigations are typically spearheaded by the FBI, in conjunction with specialized agencies such as HHS-OIG (for healthcare), the Defense Criminal Investigative Service (DCIS), or the IRS Criminal Investigation Division (IRS-CI).

The investigation process often involves:

Subpoenas and CIDs: The government will issue grand jury subpoenas or Civil Investigative Demands (CIDs) to obtain voluminous corporate records, emails, financial documents, and patient/client files.
 

Common Fact Patterns

False Claims Act violations typically arise from specific, recurring scenarios across various industries.

Upcoding: Billing for a more expensive service or procedure than was actually performed.
Unbundling: Billing separately for procedures that should be billed together at a reduced package rate.
Phantom Billing: Submitting claims for services, equipment or medications that were never provided to the patient.
Kickbacks: Paying or receiving remuneration in exchange for patient referrals, which taints all subsequent claims submitted to Medicare or Medicaid (violating the Anti-Kickback Statute and, by extension, the FCA).
Lack of Medical Necessity: Billing for procedures or tests that were not medically necessary for the patient’s condition.
Defective Pricing: Failing to provide accurate, current and complete cost or pricing data during contract negotiations.
Product Substitution: Providing the government with inferior, untested or non-conforming goods while certifying compliance with contract specifications.
 

Defense Strategies

Defending against False Claims Act allegations requires a proactive, multi-faceted approach. Experienced federal defense attorneys employ several strategies to defeat or mitigate these charges.

Lack of Knowledge (Scienter): The defense may argue that the false claims were the result of innocent mistakes, clerical errors, or a misunderstanding of complex, ambiguous regulations. If the defendant did not act with actual knowledge, deliberate ignorance, or reckless disregard, there is no FCA liability.
Lack of Materiality: Following the Supreme Court’s decision in *Universal Health Services v. United States ex rel. Escobar*, the false statement must be “material” to the government’s payment decision. If the government regularly pays a particular type of claim in full despite knowing that certain requirements were violated, the defense can argue that the noncompliance was not material.
Public Disclosure Bar: In *qui tam* cases, the defense can move to dismiss the lawsuit if the allegations were already publicly disclosed in the news media, government reports, or prior litigation, unless the whistleblower was the “original source” of the information.
Early Intervention and Presentation: Defense counsel will often seek to meet with federal prosecutors early in the investigation to present exculpatory evidence, explain the business practices, and persuade the DOJ to decline intervention in a *qui tam* suit or decline criminal prosecution.
Statute of Limitations: The FCA has a strict statute of limitations. Civil actions must generally be brought within six years of the violation, or within three years of when the government knew or should have known about the facts, but no more than ten years after the violation.
Negotiating Favorable Settlements: If liability is clear, the defense will focus on negotiating a civil settlement that minimizes the multiplier on damages, avoids criminal charges, and prevents exclusion from government programs.
 

Consequences Beyond Prison

The collateral consequences of a False Claims Act investigation or conviction are often as devastating as the statutory penalties.

Asset Forfeiture: The government frequently utilizes civil and criminal asset forfeiture to seize bank accounts, real estate, and luxury assets allegedly derived from the fraud. This can cripple a business’s ability to operate and fund its legal defense.
Exclusion and Debarment: Healthcare providers convicted of criminal fraud face mandatory exclusion from Medicare, Medicaid and all other federal healthcare programs. Government contractors face suspension and debarment from bidding on future federal contracts. For many businesses, this represents a corporate death sentence.
Professional License Loss: Physicians, nurses, accountants and attorneys will face disciplinary action by their respective state licensing boards, almost certainly resulting in the revocation or suspension of their professional licenses.
Treble Damages and Penalties: In civil FCA cases, defendants are liable for three times the government’s actual damages, plus statutory penalties of up to nearly $28,000 for *each* false claim submitted. In cases involving thousands of invoices, the financial exposure can easily reach tens of millions of dollars.

A: A *qui tam* lawsuit is a civil action brought by a private citizen (a “relator” or whistleblower) on behalf of the federal government, alleging violations of the False Claims Act. These lawsuits are filed under seal, meaning you will not know about them while the DOJ investigates. If the government intervenes and recovers money, the whistleblower can receive between 15% and 25% of the recovery. If you suspect an employee is gathering documents or acting unusually, you should consult counsel immediately.

A: No. The False Claims Act requires that the false claim be submitted “knowingly,” which includes deliberate ignorance or reckless disregard. Innocent mistakes, clerical errors, or negligence do not violate the FCA. However, if the government believes your “mistakes” were intentional or the result of a systemic failure to implement compliance protocols, they may pursue criminal charges under 18 U.S.C. § 287, which carries up to five years in prison per count.

 

A: Do not interfere with the search, but do not consent to any expansion of the warrant’s scope. Ask for a copy of the warrant and the lead agent’s business card. Most importantly, **do not answer any questions** or attempt to explain the situation to the agents. State clearly that you wish to speak with your attorney, and contact a federal criminal defense lawyer immediately. Send non-essential employees home to prevent them from being interviewed without counsel present.

 

A: A CID is a powerful discovery tool used by the DOJ to obtain documents, written answers to interrogatories, and oral testimony during a False Claims Act investigation. Receiving a CID means you or your company are under investigation. You must not destroy any documents after receiving a CID, as this constitutes obstruction of justice. You need an attorney to negotiate the scope of the CID and manage the production of documents.

 

A: The government calculates its “actual damages” (the amount it paid out due to the false claims) and then multiplies that figure by three (treble damages). In addition, the court assesses a mandatory civil penalty for each individual false claim submitted. Because healthcare providers and contractors often submit thousands of claims, the total financial exposure can be astronomical, often exceeding the net worth of the company.

 

A: In many cases, yes. Corporate bylaws or employment agreements often contain indemnification clauses that require the company to advance legal fees for officers, directors or employees facing investigations related to their job duties. However, if the company is also under investigation, you will likely need separate, independent counsel to avoid conflicts of interest.

 

A: Yes. Many civil False Claims Act cases are resolved through settlement agreements where the defendant agrees to pay a negotiated sum and enter into a Corporate Integrity Agreement (CIA) without formally admitting liability. This allows the business to continue operating and avoids the risk of a catastrophic trial verdict. However, negotiating these settlements requires skilled legal representation to protect against parallel criminal charges. — ### References [1] Law Offices of Paul D. Scott. “Fundamentals of the False Claims Act.” https://lopds.com/fundamentals-of-the-false-claims-act/ [2] U.S. Department of Justice. “False Claims Act Settlements and Judgments Exceed $6.8B in Fiscal Year 2025.” https://www.justice.gov/opa/pr/false-claims-act-settlements-and-judgments-exceed-68b-fiscal-year-2025 [3] U.S. Department of Justice. “Wound Graft Company Owners Sentenced for $1.2B Health Care Fraud.” https://www.justice.gov/opa/pr/wound-graft-company-owners-sentenced-12b-health-care-fraud-and-agree-pay-309m-resolve-civil

 

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Facing federal charges? Call now for a free, confidential consultation with an experienced federal defense attorney who has handled these cases for over 30 years.

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Myles A. Schneider

30+ Years Federal Defense Experience

U.S. Army Veteran (82nd Airborne)

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