Source: https://agovernmentofthepeople.com/2013/10/28/false-claims-act/
Timestamp: 2019-04-25 11:57:27+00:00

Document:
The False Claims Act (31 U.S.C. §§ 3729–3733, also called the “Lincoln Law“) is an American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs. The law includes a “qui tam” provision that allows people who are not affiliated with the government to file actions on behalf of the government (informally called “whistleblowing“). Persons filing under the Act stand to receive a portion (usually about 15–25 percent) of any recovered damages. Claims under the law have typically involved health care, military, or other government spending programs, and dominate the list of largest pharmaceutical settlements. The government has recovered nearly $22 billion under the False Claims Act between 1987 (after the significant 1986 amendments) and 2008.
The American Civil War (1861–1865) was marked by fraud on all levels, both in the Union north and the Confederate south. During the war, unscrupulous contractors sold the Union Army decrepit horses and mules in ill health, faulty rifles and ammunition, and rancid rations and provisions, among other unscrupulous actions. In response, Congress passed the False Claims Act on March 2, 1863, 12 Stat. 696. Because it was passed under the administration of PresidentAbraham Lincoln, the False Claims Act is often referred to as the “Lincoln Law”.
Importantly, a reward was offered in what is called the qui tam provision, which permits citizens to sue on behalf of the government and be paid a percentage of the recovery. Qui tam is an abbreviated form of the Latin legal phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur (“he who brings a case on behalf of our lord the King, as well as for himself”) In a qui tam action, the citizen filing suit is called a “relator”. As an exception to the general legal rule of standing, courts have held that qui tam relators are “partially assigned” a portion of the government’s legal injury, thereby allowing relators to proceed with their suits.
The most commonly used of these provisions are the first and second, prohibiting the presentation of false claims to the government and making false records to get a false claim paid. By far the most frequent cases involve situations in which a defendant—usually a corporation but on occasion an individual—overcharges the federal government for goods or services. Other typical cases entail failure to test a product as required by the rigorous government specifications or selling defective products.
The False Claims Act was amended in 1943 to, most notably, reduce the relator’s share of the recovered proceeds.* The law was again amended in 1986. By that time, there was great concern that the national deficit had risen dangerously and President Ronald Reagan had declared that a vast amount of government spending was being misused through waste and fraud.
After the 1986 amendments strengthening the Act were passed (see below), the Act was used primarily against defense contractors. By the late 1990s, however, the focus had shifted to health care fraud, which now accounts for the majority of cases filed by whistleblowers and by the government.
Under the False Claims Act, the Department of Justice is authorized to pay rewards to those who report fraud against the federal government in an amount of between 15 and 30 percent of what it recovers based upon the whistleblower’s report.
the complaint must be buttressed by a comprehensive memorandum, not filed in court, but served on the government detailing the factual underpinnings of the complaint.
Employment protection for whistleblowers including reinstatement with seniority status, special damages, and double back pay.
Increased the Attorney General‘s power to delegate authority to conduct Civil Investigative Demands prior to intervening in an FCA action.
Submitting for payment or reimbursement a claim known to be false or fraudulent.
Making or using a false record or statement material to a false or fraudulent claim or to an ‘obligation’ to pay money to the government.
Engaging in a conspiracy to defraud by the improper submission of a false claim.
Concealing, improperly avoiding or decreasing an ‘obligation’ to pay money to the government.
Changes to the Public Disclosure Bar. Under the previous version of the FCA, cases filed by private individuals or “relators” could be barred if it was determined that such cases were based on a public disclosure of information arising from certain proceedings, such as civil, criminal or administrative hearings, or news media reports. As a result, defendants frequently used the public disclosure bar as a defense to a plaintiff’s claims and grounds for dismissal of the same. PPACA amended the language of the FCA to allow the federal government to have the final word on whether a court may dismiss a case based on a public disclosure. The language now provides that “the court shall dismiss an action unless opposed by the Government, if substantially the same allegations or transaction alleged in the action or claim were publicly disclosed.” See 31 U.S.C. 3730(e)(4)(A).
Original Source Requirement. A plaintiff may overcome the public disclosure bar outlined above if they qualify as an “original source,” the definition of which has also been revised by PPACA. Previously, an original source must have had “direct and independent knowledge of the information on which the allegations are based.” Under PPACA, an original source is now someone who has “knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions.” See 31 U.S.C. 3730(e)(4)(B).
Overpayments. FERA redefined “obligation” under the FCA to include “retention of any overpayments.” Accordingly, such language imposed FCA liability on any provider who received Medicare/Medicaid overpayments (accidentally or otherwise) and fails to return the money to the government. However, FERA also raised questions as to what exactly is involved in the “retention of overpayments” – for example, how long a provider had to return monies after discovering an overpayment. PPACA clarified the changes to the FCA made by FERA. Under PPACA, overpayments under Medicare and Medicaid must be reported and returned within 60 days of discovery, or the date a corresponding hospital report is due. Failure to timely report and return an overpayment exposes a provider to liability under the FCA.
Statutory Anti-Kickback Liability. The federal Anti-Kickback Statute, 42 U.S.C. 1320a-7b(b) (AKS) is a criminal statute which makes it improper for anyone to solicit, receive, offer or pay remuneration (monetary or otherwise) in exchange for referring patients to receive certain services that are paid for by the government. Previously, many courts had interpreted the FCA to mean that claims submitted as a result of AKS violations were false claims and therefore gave rise to FCA liability (in addition to AKS penalties). However, although this was the “majority rule” among courts, there were always opportunities for courts to hold otherwise. Importantly, PPACA changed the language of the AKS to provide that claims submitted in violation of the AKS automatically constitute false claims for purposes of the FCA. Further, the new language of the AKS provides that “a person need not have actual knowledge … or specific intent to commit a violation” of the AKS. Accordingly, providers will not be able to successfully argue that they did not know they were violating the FCA because they were not aware the AKS existed.
The False Claims Act has a detailed process for making a claim under the Act. Mere complaints to the government agency are insufficient to bring claims under the Act. A complaint (lawsuit) must be filed in U.S. District Court (federal court) in camera (under seal). After an investigation by the Department of Justice within 60 days, or frequently several months after an extension is granted, the Department of Justice decides whether it will pursue the case.
If the case is pursued, the amount of the reward is less than if the Department of Justice decides not to pursue the case and the plaintiff/relator continues the lawsuit himself. However, the success rate is higher in cases that the Department of Justice decides to pursue.
move to dismiss the relator’s complaint, either because there is no case, or the case conflicts with significant statutory or policy interests of the United States.
advise the relator that the Department of Justice intends to decline intervention. This usually, but not always, results in dismissal of the qui tam action, according to the U.S. Attorneys’ Office of the Eastern District of Pennsylvania.
There is case law where claims may be prejudiced if disclosure of the alleged unlawful act has been reported in the press, if complaints were filed to an agency instead of filing a lawsuit, or if the person filing a claim under the act is not the first person to do so. Individual states in the U.S. have different laws regarding whistleblowing involving state governments.
In a 2000 case, Vermont Agency of Natural Resources v. United States ex rel. Stevens, 529 U.S. 765 (2000), the United States Supreme Court held that a private individual may not bring suit in federal court on behalf of the United States against a State (or state agency) under the FCA. In Stevens, the Supreme Court also endorsed the “partial assignment” approach to qui tam relator standing to sue, which had previously been articulated by the Ninth Circuit Federal Court of Appeals and is an exception to the general legal rule for standing.
In a 2007 case, Rockwell International Corp. v. United States, the United States Supreme Court considered several issues relating to the “original source” exception to the FCA’s public-disclosure bar. The Court held that (1) the original source requirement of the FCA provision setting for the original-source exception to the public-disclosure bar on federal-court jurisdiction is jurisdictional; (2) the statutory phrase “information on which the allegations are based” refers to the relator’s allegations and not the publicly disclosed allegations; the terms “allegations” is not limited to the allegations in the original complaint, but includes, at a minimum, the allegations in the original complaint as amended; (3) relator’s knowledge with respect to the pondcrete fell short of the direct and independent knowledge of the information on which the allegations are based required for him to qualify as an original source; and (4) the government’s intervention did not provide an independent basis of jurisdiction with respect to the relator.
In a 2008 case, Allison Engine Co. v. United States ex rel. Sanders, the United States Supreme Court considered whether a false claim had to be presented directly to the Federal government, or if it merely needed to be paid with government money, such as a false claim by a subcontractor to a prime contractor. The Court found that the claim need not be presented directly to the government, but that the false statement must be made with the intention that it will be relied upon by the government in paying, or approving payment of, a claim. TheFraud Enforcement and Recovery Act of 2009 reversed the Court’s decision and made the types of fraud to which the False Claims Act applies more explicit.
In a 2009 case, United States ex rel. Eisenstein v. City of New York, the United States Supreme Court considered whether, when the government declines to intervene or otherwise actively participate in a qui tam action under the False Claims Act, the United States is a “party” to the suit for purposes of Federal Rule of Appellate Procedure 4(a)(1)(A) (which requires that a notice of appeal in a federal civil action generally be filed within 30 days after entry of a judgment or order from which the appeal is taken). The Court held that when the United States has declined to intervene in a privately initiated FCA action, it is not a “party” for FRAP 4 purposes, and therefore, petitioner’s appeal filed after 30 days was untimely.
Twenty-nine states and the District of Columbia have also created false-claims statutes to protect their publicly funded programs from fraud by including qui tamprovisions, which enables them to recover money at state level. Twenty of these state False Claims Act statutes provide similar protections to those of the federal law, while ten states have laws which limit recovery to claims of fraud related to theMedicaid program.
The California False Claims Act was enacted in 1987, but lay relatively dormant until the early 1990s, when public entities, frustrated by what they viewed as a barrage of unjustified and unmeritorious claims, began to employ the False Claims Act as a defensive measure. Recent developments in the California False Claims Act reduce the defenses contractors have to false claim prosecutions, by stripping away immunities that were believed to apply to certain classes of statements and claims. As a result, contractors can expect to see their payment claims answered by false claims accusations with increasing frequency.
It has recently been argued that legislation modeled on the False Claims Act should be introduced in Australia and apply to the tobacco industry and carbon pricing schemes among others in an effort to save the Australian government millions, if not billions, of dollars currently being lost to contractor fraud.
In October 2013, the UK Government announced that it is considering the case for financially incentivising individuals reporting fraud in economic crime cases by private sector organisations, in an approach much like the US False Claims Act.The ‘Serious and Organised Crime Strategy’ paper released by the UK’s Secretary of State for the Home Department sets out how that government plans to take action to prevent serious and organised crime and strengthen protections against and responses to it. The paper asserts that serious and organised crime costs the UK more than £24 billion a year. In the context of anti-corruption, the paper acknowledges that there is a need to not only target serious and organised criminals but also support those who seek to help identify and disrupt serious and organised criminality. Three UK agencies (the Department for Business, Innovation & Skills), the Ministry of Justice and the Home Office have been tasked with considering the case for a US-style False Claims Act in the UK. It is argued that Australia will be watching the steps taken by the UK in this regard carefully.
Under Rule 9(b) of the Federal Rules of Civil Procedure, allegations of fraud or mistake must be pleaded with particularity. The application of the Rule 9(b) pleading standard to claims made under the False Claims Act, however, has generated much litigation, and there remains a split among the federal appeals courts surrounding the specificity of the factual matter which needs to be alleged in order to plead a sufficient False Claims Act complaint. While the First Circuit,the Fifth Circuit, and the Seventh Circuit have ruled that whistleblowers under the False Claims Act are not required to allege specific false claims to satisfy Rule 9(b), the Eleventh Circuit, the Sixth Circuit, the Eighth Circuit, and the Tenth Circuit have all found that plaintiffs must allege specific false claims.
In 2010, the First Circuit decision in U.S. ex rel. Duxbury v. Ortho Biotech Prods., L.P.(2009) and the Eleventh Circuit ruling in U.S. ex rel. Hopper v. Solvay Pharms., Inc.(2009) were both appealed to the U.S. Supreme Court. The Court denied certiorari for both cases, however, declining to resolve the divergent appeals court decisions.
In 2010, a subsidiary of Johnson & Johnson agreed to pay over $81 million in civil and criminal penalties to resolve allegations in a FCA suit filed by two whistleblowers. The suit alleged that Ortho-McNeil-Janssen Pharmaceuticals, Inc. (OMJPI) acted improperly concerning the marketing, promotion and sale of the anti-convulsant drug Topamax. Specifically, the suit alleged that OMJPI “illegally marketed Topamax by, among other things, promoting the sale and use of Topamax for a variety of psychiatric conditions other than those for which its use was approved by the Food and Drug Administration, (i.e., “off-label” uses).” It also states that “certain of these uses were not medically accepted indications for which State Medicaid programs provided coverage” and that as a result “OMJPI knowingly caused false or fraudulent claims for Topamax to be submitted to, or caused purchase by, certain federally funded healthcare programs.
Two qui tam lawsuits brought by whistleblowers (“Relators”) under the provisions of the Federal False Claims Act (FCA) has resulted in a significant recovery for taxpayers. The $22 Million state and federal recovery resolves the Relators allegations that Schwarz Pharma Inc. and its subsidiary Kremers Urban, LLC sold drugs to Medicaid that had never been approved by the Food and Drug Administration for safety and effectiveness as required by law. Pursuant to the settlement, the two whistleblowers will receive a total of $1,836,575 from the federal share and additional amounts from the states. The settlement resolves allegations against Schwarz in two separate multi-defendant whistleblower actions captioned United States ex rel. Constance Conrad v. Schwarz Pharma, et al., No. 02-11738-NG (D. Mass.), and United States ex rel. James Conrad v. Kremers Urban, et al., Civil No. 08-cv-428 (S.D. Tex.).
^ http://www.taf.org/FCA-stats-DoJ-2008.pdf Comprehensive information regarding FCA statistics may be found at http://www.taf.org/statistics.htm, including information regarding recoveries in individual cases.
^ “Qui Tam A History”. Whistleblower Info. Retrieved 2012-01-23.
^ “When Bad Things Happen to Good Rogues”. Pacific Standard. Retrieved 29 August 2013.
^ Opinion of the Court, Allison Engine Co. v. United States ex rel. Sanders, 553 U. S. __ (2008), part II(C).
^ James F. Barger Jr., Pamela H. Bucy, Melinda M. Eubanks, Marc A. Raspanti, “States, Statutes, and Fraud: An Empirical Study of Emerging State False Claims Acts,” Tulane Law Review (2005).

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