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Jul 10, 2015 by |

False Claims Act Developments for Healthcare Providers


Fraud investigation and enforcement activity against healthcare providers has been increasing, as the government uses the False Claims Act to pursue whistleblowers’ claims of fraud and abuse. This has been particularly evident with long-term care providers.

The False Claims Act, sometimes referred to as the Lincoln Law, was enacted during the Civil War to protect the Union Army from dishonest defense contractors. Its scope and use has widened broadly since then, and the False Claims Act can be used for the United States government to recover monetary damages.

False Claims Act cases are usually initiated by whistleblowers, or relators, and in turn, the whistleblower is entitled to a portion of any recovery. The False Claims Act has been amended three times since 1986, making it easier for whistleblowers to file complaints and ultimately leading to an increase in both the number of complaints and the amount recovered. For example, there were 30 such complaints in 1986, and over 700 in 2014. In 2014, the Department of Justice recovered over $5.7 billion, with $2.5 billion of that coming from the healthcare industry.

There has specifically been a dramatic increase in the False Claims Act investigations against long-term care providers after a 2009 report by the Department of Health and Human Services Office of Inspector General revealed that up-coding in Medicare claims at approximately 20% of skilled nursing facilities had led to improper charges of $1.2 billion. For long-term care providers, this means they will have to be even more vigilant regarding compliance and legal issues.

Evans Law Firm, Inc. handles whistleblower and qui tam/False Claims Act lawsuits. If you have a potential qui tam claim, please contact Evans Law Firm, Inc. at 415-441-8669 or via email at

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