What Are The Biggest Kinds of False Claims Act Cases?

The biggest, and most frequent, kinds of cases brought under the False Claims Act are for health care-related fraud.  There are a few reasons for this. Firstly, there is a large amount of government funds involved in the administration of health care. Secondly, Medicare and Medicaid have specific rules, which health care providers, pharmaceutical companies, and medical device companies are required to follow to protect patient safety. When those companies do not follow the rules, they can be liable under the False Claims Act.

How Does This Commonly Happen?

There are lots of ways medical providers have been found liable and for large amounts of money. Sometimes there are service providers who conduct medically unnecessary procedures on a routine basis. Other times they simply charge for work that was not done. Charging for work not done, is a fraud which is not solely within the province of health care. However, the way claims are billed to the government in health care can make it more likely that someone would bill for no actual work in this industry. In a bill charged to Medicare, the actual service is not provided directly to the government, but rather to the individual who needs health care. It can, therefore, be more difficult for the government to know exactly what happened, and there are some service providers who have tried to take advantage of this process.

Other times a pharmaceutical company will market a drug for what is called an “off label” use.    Since doctors can prescribe a drug for any use, if a drug company illegally markets the drug for something, which is not approved by the FDA, it can create many sales paid by Medicare. While the doctor is allowed to prescribe a drug for any condition, the drug company cannot promote the drug for a use the FDA has not approved. So, such prescriptions can become the subject of a False Claims Act case. Sometimes the way companies steer business can be the subject of a case. The Anti-Kickback Statute and the Stark Laws now broadly prohibit most practices that illegally influence doctors to use one form of medical service or recommend one form of medical service over another. Violations of those laws can make for strong cases under the False Claims Act.

What Are Big False Claims Act Cases Besides Health Care Fraud?

The next largest area of False Claims Act cases involves defense contractor fraud. This is eerily appropriate in as much as the Act was created to fight fraud committed against the Union Army in the Civil War. Back in 1863 unscrupulous contractors were providing threadbare uniforms and taking advantage of the government at every opportunity. That is how the law got its start. Alas defense contractor fraud still occurs today.

Any kind of fraud committed against the government can be the subject of a suit under this law.  Since the government is involved in funding so many different kinds of operations, there is almost no limit to the kinds of cases, which can be filed and pursued successfully under the False Claims Act.