Experienced False Claims Act Defense Attorneys for Health Care Professionals

The False Claims Act is a federal statute that allows the government to prosecute falsely or fraudulently submitted bills to federal health care programs such as Medicare, Medicaid, Tricare, or federal workers’ compensation in civil or criminal proceedings. Defending False Claims Act allegations is a delicate task. For one, it is often unclear at the beginning of the case whether the corresponding investigation is civil or criminal in nature. Notably, the False Claims Act is a hybrid statute that allows both civil and criminal penalties.

The fraud defense attorneys of the Oberheiden & McMurrey, LLP offer clients not just a long list of successful False Claims Act outcomes (see our track record below), but also the experience from former federal prosecutors that used to prosecute False Claims Act cases and now provide that knowledge and these first-hand insights to our clients. Ask False Claims Act lawyers Lynette Byrd or Dr. Nick Oberheiden how the False Claims Act defense process works in practice.

Qui Tam Explained

The False Claims Act at 31 U.S.C. Sec. 3729 invites private citizens (“relators”) to bring a lawsuit against individuals or businesses that have committed health care fraud, typically large-scale Medicare fraud (“Qui Tam”). To incentivize such reporting and disclosing, the statute assigns successful relators monetary rewards collected on behalf of the United States. The law rewards qui tam plaintiffs by allowing them to keep up to 25 percent of any amount collected if the government participates in the litigation and up to 30 percent if the plaintiffs collect on their own without the government’s support.

In this initially confidential process, the government will review the lawsuit and assess its merits. If the lawsuit attracts the government’s attention and interest, the government may join the relator and intervene, or otherwise decline intervention and let the relator continue the case without the support of the government and its lawyers. If the government decides to assist and to intervene, the government will, depending on the facts and the severity and dimension of the fraud, initiate either a civil or criminal investigation (or sometimes both, called parallel investigation) against the defendants. That investigation is often run with the help of the OIG and FBI as well as federal prosecutors from the U.S. Attorney’s Office. Successful qui tam lawsuits can result in significant fines and liabilities for the defendants.

Who Is at Risk?

The False Claims Act applies to health care providers and businesses that directly or indirectly contract with and are paid for services by the United States government. Particularly scrutinized are the following health care industries:

  • Pharmaceutical Sales
  • Toxicology Laboratories
  • Home Health & Hospice Centers
  • DME & Hospitals
  • DNA Testing Facilities
  • Large Physician Groups

False Claims Act investigations are often prompted by disgruntled former employees who report misconduct allegedly witnessed or observed to government agencies.

What Are the Penalties?

The False Claims Act is a hybrid law that contains both civil and criminal penalties.

Civil Liability:

Triple damages and a penalty of up to $ 11,000 per claim for anyone who knowingly submits or causes submission of a false or fraudulent claim to the United States, see 31 U.S.C. Sec. 3729.

Criminal Liability:

Health care providers who intentionally present false claims to the government for reimbursement with the knowledge that such claims were false, fictitious, or fraudulent are exposed to five years imprisonment and a fine of $250,000 (individuals) or $500,000 (companies) for federal felony convictions and $100,000 (individuals) or $200,000 (companies) for misdemeanor convictions— for each claim, see 18 U.S.C. Sec. 287).

Our Results (False Claims Act)

The difference in outcome between human error and jail time is often a fine line that requires convincing negotiation skills and knowledge of the law. The false claims act defense attorneys of Oberheiden & McMurrey, LLP have extensive False Claims Act knowledge demonstrated in proceedings and courts across the country. Here are sample outcomes of our previous False Claims Act engagements:

  • Defense of Medicare Laboratory in a False Claims Act Investigation by the Department of Justice and the U.S. Attorney’s Office
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Health Care Services Company in a False Claims Act Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.
  • Defense of Medicare Laboratory in a False Claims Act Investigation by the Department of Health and Human Services and the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of Nationally Operating Health Care Business in a False Claims Act Investigation by the Department of Defense
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Health Care Marketing Business in a False Claims Act Investigation by the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Department of Justice
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by various branches of the federal government
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Department of Defense
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Department of Justice
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Physician Owned Entity in a False Claims Act Investigation by the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.
  • Defense of a Health Care Management Organization in a False Claims Act Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.

Contact our offices today to speak with an experienced attorney who can help protect your rights. We offer a free initial case evaluation and consultation.