Building a False Claims Act Case

Building a false claims act case always requires a great deal of time and effort for any whistleblower. Usually, it is the whistleblower who must teach everyone else about the underlying industry in which they work. Lawyers working for the Department of Justice or even the whistleblower’s own counsel may understand the False Claims Act. However, the expert in the industry that generates the fraud is almost always the whistleblower. Contact a professional false claims act attorney for more on the subject.

Healthcare Cases

It can be a False Claims Act type of case in healthcare and that may be an area that all the lawyers involved – they government lawyer, the private attorney – may have quite a bit of experience with because the vast majority of all cases brought under the False Claims Act involve healthcare claims. It is a vast area with many sub-specialties. Even within healthcare, it may be that the whistleblower works for a particular type of lab or in a particular type of billing environment, or the whistleblower works conducting a particular type of procedure. In those events, usually, it is the whistleblower who understands why the claim is fraud. The whistleblower will understand more about how the individual business operated as well. They may not understand how the False Claims Act works and what the procedure is to bring the case, but a good whistleblower, whether they realize it or not, has the important information.

Length of Time for a Case

One of the things to keep in mind when building a false claims act case is that it is a lengthy process. The initial filings can take a lot of work and time. Once the case is filed, the next step of building the false claims act case is to meet with the government and explain to them why the case should be valuable to them. They may ask for additional information or explanations from the whistleblower through the whistleblower’s attorneys. It can feel like the whole process begins again. The questions are constantly being reviewed regarding what exactly is the law that has been violated? What exactly is the claim that was presented to the government that is false? Why exactly is that claim false? How do we determine whether or not the government would have paid for that claim?

These questions will come up again and again and, essentially, a whistleblower and the attorney must continue to build and re-build the false claims act case in order to determine exactly how strong the case they can have and in order to help convince the government that it is a case worth bringing.

Elements to Build a Strong Case

Building a strong case starts with a strong claim based on a strong set of facts that would lead everyone to believe that the government has been defrauded and facts that shows that the government would not have paid. The next element would be to show how much money was involved in the fraud. The False Claims Act is meant to recover funds for the government. The more damages the whistleblower and their attorneys can uncover, the more likely it is that the government will pursue the case and, of course, the more money for the government to collect.

Public Policy Issues

Finally, it is always useful to know, if there is an additional public policy issue making the decision to pursue the case more compelling. There are many types of False Claims Act cases. A lot of them only involve money and that is, in and of itself, its own public policy reason. It is after all the taxpayers being defrauded, it is the government being defrauded and that is the money at stake. The False Claims Act has its own public policy importance. It is also true that when there is fraud committed against the government in terms of financial loss, there is often also fraud that creates some form of additional public harm. It is quite often in health care that when fraud is involved, there is also potential patient harm.

It is often the case in contracting with the defense department and other agencies of the United States Government that when there is fraud committed against the government, there is harm committed against individuals who work for the government and service people could be at risk.

Showing False Claim

To build a strong false claims act case, to show liability, a person has to show that there was a false claim, they have to show that that false claim was made to the government and then was material to the government’s decision to pay. They can use regulations and laws to show that the government would not have paid. The anti-kickback section, Stark Law – all kinds of regulations related to the decision to pay may be brought in to help build on this position. It can be a complicated situation. Call an attorney today for more legal guidance.