False Claims Act

Experienced Raleigh Attorneys for False Claims Act Investigations

The False Claims Act is a federal statute that imposes civil and criminal penalties for healthcare providers who submit fraudulent reimbursement claims to Medicare, Medicaid and other federal benefit programs. The government can choose to investigate healthcare providers under the False Claims Act independently; or, it can launch an investigation in response to the filing of a qui tam lawsuit.

Cheshire Parker Schneider's Raleigh-based healthcare fraud defense team has decades of experience representing health care providers in North Carolina and elsewhere. Our goal in every case is to end our client’s investigation before it causes irreparable harm. As a result, early intervention is critical, and we encourage you to contact us as soon as possible.

The False Claims Act: An Overview

Each year, the federal government pays billions of dollars in false and fraudulent claims under Medicare, Medicaid and other healthcare benefit programs. The False Claims Act is intended to help combat this fraud by (i) imposing severe penalties for submitting false and fraudulent claims, and (ii) allowing private citizens to file claims on behalf of the government (qui tam actions) and receive a portion of any amounts recovered.

Due to the statute’s breadth, a wide variety of Medicare and Medicaid billing practices can lead to scrutiny under the False Claims Act. However, in addition to relying on private citizens to report suspected fraud, the government is increasingly relying on data analytics to identify potential targets for False Claims Act investigations. As a result, legal but “abnormal” billing practices will often result in physicians, hospitals and other healthcare providers being forced to defend themselves against civil and criminal charges.

A key aspect of the False Claims Act that distinguishes it from certain other healthcare fraud statutes (such as the Stark Law) is that it requires knowledge of the offense in order to face liability. In other words, if you did not knowingly submit a false claim, you are not liable under the False Claims Act. However, if you should have known of the submission with reasonable diligence, you can be charged with “knowingly” violating the law even if you did not have actual knowledge of the false claim being submitted.

Penalties for False Claims Act Violations

The penalties for violating the False Claims Act are severe. In a civil case, the potential penalties include:

  • Fines of $11,000 per false claim
  • Treble (triple) damages for fraudulently-billed claims
  • Exclusion from Medicare, Medicaid and other healthcare benefit programs

In criminal cases under the False Claims Act, defendants can face:

  • Tens or hundreds of thousands of dollars in financial penalties
  • Up to five years of federal incarceration

Physicians charged with violating the False Claims Act in North Carolina can face license suspension or revocation as well.

In False Claims Act investigations, in addition to challenging the government’s evidence regarding knowledge of the alleged violation(s), a key defense strategy involves focusing on keeping the investigation civil in nature. With prison time off the table, our attorneys can focus on challenging the government’s evidence and, if necessary, negotiating a resolution that allows you to keep your practice or business up and running. However, our primary goal in every case is to favorably conclude the government’s investigation before it leads to civil or criminal charges.

Speak with a Raleigh Healthcare Fraud Defense Lawyer at Cheshire Parker Schneider

To inquire about hiring our Raleigh healthcare fraud defense attorneys for your False Claims Act investigation, please call (919) 833-3114 or contact us online now. We will make arrangements to meet with you in confidence as soon as possible.