Defining A “False Claim” Under Federal Law
There’s no denying that entering a whistleblower lawsuit comes with its fair share of challenges and demanding situations. But then again, it can also be very freeing, provided that you know how to handle the situation. And that’s why you need to know what is defined as a false claim under the federal law. Having that information is extremely helpful, and it can be super handy especially as you work with a great FCA lawyer.
Defining false claims
A false claim occurs when the claim request is knowingly fraudulent or false. Knowingly doesn’t require proof of intent. It just includes cases where the person acts knowing of the falsity, and they ignore the truth they know, while also being in reckless disregard of the truth as well.
What is defined as a false claim?
Clearly, there are a lot of false claims out there, each one with their own type of challenges and issues you might face. The most important thing when it comes to false claims is to understand how to define them and to identify them when necessary.
- Healthcare frauds involve submitting Medicaid or Medicare claims for services that were not offered. It can also include billing for more expensive procedures or falsely certifying compliance with healthcare regulations.
- It can also include things like inflating expenses on governmental projects, mis-representing labor costs or overhead, or charging for materials/equipment that were not used.
- The same thing is valid when it comes to signing forms certifying legal compliance while violating those laws knowingly. Falsely stating that funds were spent appropriately is another thing that will be a false claim.
- There are also government contract frauds as well. That would be when you bill the government for products/services that were never delivered, charging for defective materials/substandard work, mis-representing contract compliance or anything of that nature.
As you can see, these false claims can appear in a variety of situations, and they do get really problematic more often than not. Understanding how to deal with them and managing the situation adequately is crucial, and you have to approach this with the utmost care. That way, it will become easier to manage the situation, while also adapting to it and handling things in an appropriate manner.
Claims vs statements
A false claim doesn’t have to be a formal invoice. It can be an electronic request for payment, certifications/statements related to obtaining the payment, but also any representation that shows the government is paying money and the claimant is not entitled to getting the money. In these cases, materiality is very important, because the false statement needs to have a real impact on the government’s decision to approve/pay any of the funds.
In order for a claim to be actionable, the claim/false statement needs to be material to the government’s own payment decision. If there are unintentional mistakes or trivial errors, these are normally not enough, and that’s certainly something to take into consideration.
The FCA will include ignorant and reckless misstatements, courts will usually focus on any patterns of misconduct. For example, they will look for situations where you hide defective products, while also submitting claims, altering invoices to try and increase payments, or anything else of that nature.
How can you distinguish fraud from an honest mistake?
That’s the thing, a lot of the time mistakes are being made, and some people will interpret them as fraud, even if that’s not the case at all. The most important thing is to identify what led to those problems, and how you can tackle those in a way that’s appropriate and distinctive.
Clerical mistakes or errors will not qualify, and the same thing is valid when it comes to disagreements made over billing interpretations. You can also state that about correctable reporting errors. It usually comes down to showing that the issues had intent behind them, otherwise there won’t be a valid case and you won’t need a False Claims Act Lawyer to represent you.
As a whistleblower, you always want to make sure that you provide enough evidence to support your claim. The court will look for intent, and if there is no intent, then that’s totally a thing you have to take into consideration here. Knowing how to handle that process and adapting it to your requirements will also help way more than you might expect.
Conclusion
Clearly, having a great FCA lawyer by your side is crucial if you are dealing with a whistleblower case. At the end of the day, the most important thing is to show that you are sharing elements of fraud you know, and not stuff that was an honest mistake. That’s the reason why you always want to back up your claim with enough evidence, as much as possible. Once you do that, not only will it make things easier to manage, but you can prevent issues down the line.
