The Federal False Claims Act is generally known as the most powerful tool in fighting fraudulent claims against the federal government. In most instances, the Federal FCA handles claims that deal with procurement fraud and health care fraud where a contractor defrauds the government.
These types of fraud commonly occur when a government contractor files a false claim requesting payment from the government for inferior goods, undelivered products/services, unnecessary work or procedures, or kickbacks to physicians. Another important aspect of the Federal False Claims Act is that it provides private citizens with the ability to file actions exposing fraudulent acts, referred to as a “qui tam” action, on the government’s behalf.
State FCA vs. Federal False Claims Act Laws
In addition to the Federal False Claims Act, 31 U.S. states have False Claims Act laws which allow whistleblowers to expose fraudulent claims on behalf of the state. While the state—specific FCA laws commonly follow similar provisions to the federal FCA laws, there are some differences.
For example, some states’ False Claims Act laws allow for collections related to state health care funds or Medicaid fraud, whereas others do not. In other states, whistleblowers are not even permitted to fil Qui Tam actions.
When determining if the federal FCA or state FCA applies to a particular claim it is usually most helpful to look at whether the federal government or the state government has been directly victimized by the fraudulent action.
The 31 states that have enacted their own False Claims Act include:
- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- Rhode Island
State False Claims Act Laws & Medicaid
Although Medicaid fraud is often tackled under Federal FCA laws, Medicaid whistleblower lawsuits are also common under state FCA laws because funds are being misappropriated from state-specific coffers too. Just like federal Medicaid fraud, questionable Medicaid fraud and billing practices also occur on the state level when health care providers submit false claims with the anticipation of pay-outs from health care programs funded by the state government. Some examples of Medicaid fraud claims that could be processed under a set of state FCA laws, include:
- Phantom billing, where invoices are sent for services that have not been provided
- Ping ponging, a practice where a patient is unnecessarily passed from physician to physician so that a larger, overcharged invoice can be remitted to the third-party payer
- Charging for expensive equipment or medicine but using a cheaper replacement
- Unbundling, which occurs when a “package” of services is separated into individual charges to increase the entire cost of services or procedures
For more information on state-specific False Claims Act laws, contact the experienced legal team at Behn & Wyetzner for assistance with your whistleblower claim. As always, there is no charge for our consultation and all consultations are conducted in the strictest confidence.