False Claims Act – Qui Tam Claims

We represent clients concerning claims brought under the False Claims Act (FCA) and under the Georgia False Medicaid Claims Act (GFMCA).  The FCA and the GFMCA allow a private citizen, commonly known as a “whistleblower”, to sue on behalf of the United States and/or the State of Georgia in order to recover damages as a result of fraud against the government.  Such suits by private citizens are also known as “qui tam” actions.  Private citizens can potentially recover 15-30% of the recovery obtained by the United States and/or the State of Georgia.  The defendant may also be liable for treble damages (three times the amount of the damages) and for penalties of $5,500 to $11,000 per fraudulent claim.  The FCA and GFMCA also provide a cause of action to a private citizen for retaliation by an employer for the citizen’s lawful acts in the furtherance of the FCA and the GFMCA.

In 2014, we represented one whistleblower in a case in which Amedisys, Inc., a home health provider, agreed to pay $150 million to the United States to settle allegations arising out of several filed cases concerning home health billings.  This settlement is considered the largest home healthcare settlement in the history of the False Claims Act.

In the 2015 fiscal year, the Department of Justice recovered $3.5 billion in settlements and judgments from civil cases brought under the FCA.  Most of the recoveries in 2015, $1.9 billion, concerned health care fraud involving Medicare and Medicaid payments.  Since 2009, the Department of Justice recovered a total of $16.5 billion in health care fraud cases.

The legal procedures governing federal False Claims Act and Georgia False Medicaid Claims Act claims are complicated.  At the start, complaints are kept secret, “under seal”, while the Department of Justice and/or the Attorney General of the State of Georgia investigate the allegations alleged in the complaint in order to make a decision as to whether to pursue the case.  There are many pitfalls to navigate.

If you have any questions concerning a potential claim, please contact Kevin Doyle.