False Claims Act: Preparing For And Navigating Internal Complaints

An employee at a medical facility emails a supervisor with concerns that the facility is improperly billing the government for certain services. The supervisor, uncertain of what to do in response, assumes that the employee is mistaken about the situation or that the concerns have little merit. Ultimately, the supervisor decides to ignore the email, and unfortunately, such decisions can become extraordinarily costly for healthcare providers.

The False Claims Act (FCA) is a federal statute that allows individuals to file suit on behalf of the government against a person or entity that has allegedly submitted false claims to government programs, such as Medicare, Medicaid, and Tricare. These private persons—known as qui tam whistleblowers or relators—can obtain a percentage of any government recovery resulting from a lawsuit they file. Defendants in these lawsuits can be liable for three times the damages incurred by the government and penalties ranging from about