Types of Fraud That Can Qualify for a False Claims Act Case

Types of Fraud That Can Qualify for a False Claims Act Case – Part one

Many different types of conduct qualify as a violation of the False Claims Act.  Just some of the many possible types of violations that might qualify follow:

  • Any type of fraud that would cause the government to suffer a financial loss
  • Billing the government for training that wasn’t given
  • Billing Medicare and/or Medicaid for:
    • Services that weren’t performed
    • Services provided to people not eligible for Medicare or Medicaid
    • Services that weren’t performed by a required licensed professional
    • Services that weren’t necessary
  • Making claims for services the provider knew Medicare or Medicaid couldn’t authorize
  • Failing to perform necessary testing
  • False claims in the government financial housing sales sector
  • False claims for any government contract
  • Making false statements in a grant proposal
  • Making a false statement when applying for a governmental loan
  • Falsely stating the claimant’s eligibility to participate in a government program
  • Fraud involving applying for a mortgage
  • Inflating costs
  • Offering or paying kickbacks to get business
  • Selling adulterated drugs
  • Selling misbranded drugs
  • Selling products that are defective or inferior
  • Falsifying a Small Business Administration loan

In many of these cases, there are multiple occurrences of the same type of fraud.

Many disclosures will justify a False Claims Act claim if they are properly documented and comply with the False Claims Act statute. Experienced whistleblower lawyers can help clients understand when they have enough evidence and when more may be needed. At Stephen Danz & Associates, we guide you through the litigation process. To learn more about your whistleblower rights, call (877) 789-9707 today. Se habla espanol.


Types of Fraud That Can Qualify for a False Claims Act Case – Anti-Kickback Statute Violations

The Anti-Kickback Statute (42 USC § 1320a-7b(b)) is an effort to help make sure physicians and medical businesses place the patient’s health needs before making a profit.

The law forbids anyone from “offering, paying, soliciting or receiving anything of value to induce or reward referrals or generate Federal health care program business.” It covers any type of service. There must be a showing that the violation of the law was intentional.

There are voluntary safe harbors that are similar but not identical to the Stark Law exceptions. The safe harbors are voluntary, not mandatory. The safe harbors are listed in 42 CFR § 1001.952. Similar to the Stark Law exceptions, the transactions should be for fair market value, not based on volume or the value of the referral, and must many other specific requirements.

Examples of safe harbors include:

  • Certain types of investments
  • Renting office space
  • Equipment rentals
  • Personal services and management contracts
  • Selling a practice
  • Referral services
  • Warranties
  • Discounts
  • Waiving copayments
  • Reduced premiums
  • Price reductions
  • Recruiting practitioners
  • Investments in group practices
  • Ambulatory surgical centers
  • Other qualified transactions

Many disclosures will justify a False Claims Act claim if there is evidence of fraud against the government. Disclosures which involved the Anti-Kickback Statute may be subject to safe harbors. Experienced California False Claims Act lawyers explain what evidence is needed to bring a disclosure, when disclosures might be barred, and when more evidence may be required. At Stephen Danz & Associates, we have been fighting for whistleblowers and helping them get a percentage of a recovery for several decades. For help now, call (877) 789-9707 today. Se habla espanol.


Types of Fraud That Can Qualify for a False Claims Act Case – Stark Law Violations

Violating the Stark Act can lead to a valid False Act Claim. This law forbids certain types of physician referral arrangements where the referring doctor has a financial interest in the entity receiving the referral.

Stark law applies to a range of medical services (provided they meet the “designated” medical service definition. This generally include physical therapy, clinical lab services, radiology service, medical equipment, hospital services, prosthetics and much more. The Stark Laws apply to false claims to Medicare.

There are exceptions to the Stark law that may validate an otherwise illegal transaction. These exceptions are identified in the federal law – 42 CFR § 411.357. They cover numerous general areas. There are specific requirements for each area. Generally, the exceptions must be for fair market value and must be in writing. The payment arrangements can’t be based on volume or the value of any referrals. The areas covered include:

  • Renting office space
  • Renting equipment
  • Bona fide employment agreements
  • Personal service arrangements
  • Recruitment of physicians
  • Certain hospital arrangements
  • Bona fide charitable contributions
  • Other authorized matters

Many different disclosures will justify a False Claims Act claim. Sadly, there is not a limit to the types of dishonest ways people and companies can try to cheat the government. To learn if you have a viable False Claims act case, call Stephen Danz & Associates today. Our lawyers have helped many claimants over the past 30 plus years get strong percentages of the amount recovered – as a reward for valid disclosures. We guide employees, contractors, executives, and others through the disclosure and trial process.