False Claims Act Violations

While the federal False Claims Act applies to fraudulent activity against the government in a wide range of situations, it is frequently applied in Michigan when patients or government auditors believe a healthcare provider is submitting false or fraudulent claims. Actions under the False Claims Act may be highly complex, particularly when they run parallel to criminal investigations or proceedings involving the Michigan Attorney General's Office.

Those facing allegations of false claims are advised to consult an experienced Michigan False Claims Act violations lawyer even if charges have not yet been filed. A knowledgeable healthcare fraud defense attorney can advocate through any proceedings, providing advice, delving for evidence, and building the strongest possible defense to help reach a positive outcome.

Given that the federal False Claims Act dates to the time of the Civil War, it is often referred to as the Lincoln Act. While it was initially enacted to combat fraud perpetrated against the army by suppliers of defective merchandise, it has been used increasingly in recent years to combat suspected fraud in the healthcare field.

The False Claims Act—which starts at 31 U.S.C. §3729—provides civil liability for anyone who "knowingly presents, or causes to be presented, a false or fraudulent claim for payment" from the federal government or "knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim." Since so many healthcare providers accept Medicare, Medicaid, and other federally administered forms of insurance, nearly all providers may be audited and accused of presenting false or fraudulent claims under the Act.

Alleged violations of the False Claims Act in Michigan may be pursued both by operatives of the federal government and by private individuals—or their attorneys—through a qui tam provision in the law. This provision enables private individuals to step forward and blow the whistle, so to speak, on practices they believe are defrauding the government of taxpayer funds.

While the motives behind the qui tam provision may have been noble, the motivation behind lawsuits stemming from it often is not. Whistleblowers expect to receive a substantial percentage of damages recovered from a False Claims Act case, so they may be tempted to seek out potential fraud where it does not actually exist.

False and fraudulent claims that violate the Act may involve many different practices in the medical field. As a seasoned attorney could explain, some examples include:

• Offering or accepting kickbacks for the order of services or equipment paid for by the government
• Durable medical equipment fraud, which may include the provision of expensive equipment when not medically necessary
• Separately billing for services that should have bundled due to DRG or other arrangements
• Upcoding or billing for services that were more elaborate than those provided to the patient
• Prospective Payment System (PPS) claim issues
• Stark Law violations or physician referrals involving a conflict of interest
• Medical coding errors or discrepancies

These types of violations may occur by accident, in which case an argument could be made that there was no intent to defraud the government or no knowingly false claim. It may be important for a False Claims Act violations lawyer in Michigan to collect and preserve evidence on your behalf to demonstrate intent and state of mind in connection with any alleged fraudulent or false claims.

Alleged cases of healthcare fraud now make up a sizeable percentage of False Claims Act cases in Michigan. Those found liable may be required to pay damages equal to three times the amount of the loss caused by the alleged fraud, and a government-imposed fine of up to $10,000.

Other consequences of a False Claims Act could include payment of court costs and attorneys' fees, and future ineligibility to receive federal payments through Medicare and other programs. It may be wise to work with a well-practiced Michigan False Claims Act violations lawyer who can fight to protect your rights and help minimize the damage. To learn how you may be able to work toward a positive outcome in your case, call today to schedule a consultation.