The Impact of the False Claims Act on Healthcare Fraud Cases in California
The False Claims Act (FCA) is a powerful federal law designed to combat fraud against the government. Its reach extends into a wide range of industries, but its impact is particularly significant in the healthcare sector. For healthcare providers and professionals in California, understanding the FCA and its implications is critical, especially given the strict enforcement efforts by federal and state authorities.
Learn more below about the False Claims Act and its impact on healthcare fraud allegations in California. If you are under investigation or have been charged with healthcare fraud, contact the Law Offices of Art Kalantar in Beverly Hills for practical advice and effective representation from a skilled and experienced California False Claims Act defense attorney.
What Is the False Claims Act?
The False Claims Act imposes liability on individuals or entities that knowingly submit false or fraudulent claims to the government for payment. Originally enacted during the Civil War, the FCA has evolved into one of the most widely used tools for combating healthcare fraud in the United States.
A key feature of the FCA is its qui tam provision, which allows private individuals, often referred to as “whistleblowers,” to file lawsuits on behalf of the government. Whistleblowers who bring successful claims can receive a percentage of the recovered damages, incentivizing them to report suspected fraudulent activity.
How Does the FCA Apply to Healthcare Fraud?
Healthcare fraud under the FCA often involves false claims submitted to government programs such as Medicare and Medi-Cal, California’s Medicaid program. Examples of fraudulent practices include:
- Billing for services that were never provided.
- Upcoding, or billing for a more expensive service than was actually performed.
- Kickbacks for patient referrals, which violate the Anti-Kickback Statute and may trigger FCA liability.
- Providing medically unnecessary services or prescriptions and seeking reimbursement from government healthcare programs.
Given the complexity of healthcare billing and the volume of claims processed daily, healthcare providers can find themselves under investigation for FCA violations, sometimes without clear evidence of intentional wrongdoing.
The Role of Whistleblowers in Healthcare Fraud Cases
In California, healthcare fraud cases frequently begin with whistleblower actions. Employees or contractors working for healthcare providers may observe practices they believe violate the FCA and file a qui tam lawsuit. The government has the option to intervene and take over the case, but if it declines, the whistleblower can proceed independently.
The potential rewards for whistleblowers are significant. If the government or whistleblower recovers funds, the whistleblower may receive 15-30% of the total recovery. This financial incentive has led to an increase in whistleblower claims, particularly in California’s healthcare industry.
Consequences for Healthcare Providers: Penalties Under the FCA
The penalties for violating the FCA are severe. Defendants may face:
- Treble damages (three times the amount of the fraudulent claims).
- Civil penalties ranging from $13,508 to $27,018 per false claim.
- Exclusion from participation in federal healthcare programs.
For healthcare providers, these penalties can be financially devastating and can lead to the loss of professional licenses or the closure of their practices.
Defending Against FCA Claims in Healthcare
Healthcare fraud cases under the FCA can be complex, requiring a strong defense strategy tailored to the specifics of the case. Common defenses include:
- Lack of knowledge: The FCA requires proof that the defendant knowingly submitted a false claim. A lack of intent or an honest billing mistake may negate liability.
- Materiality: The false statement must be material to the government’s decision to pay the claim. Defendants may argue that the alleged misconduct was not significant enough to influence payment decisions.
- Statute of limitations: The FCA imposes a six-year statute of limitations, or up to 10 years in certain circumstances. Cases outside this time frame may be dismissed.
California’s Role in FCA Enforcement
California actively collaborates with federal authorities to investigate and prosecute healthcare fraud under the FCA. Additionally, the California False Claims Act (CFCA) mirrors the federal FCA, providing state-level enforcement tools against fraud targeting Medi-Cal and other state-funded programs.
In recent years, California has been home to several high-profile healthcare fraud cases. Federal prosecutors in Los Angeles and other regions of the state have prioritized FCA cases involving fraudulent Medicare and Medi-Cal claims, with a focus on protecting public funds and maintaining the integrity of healthcare programs.
Protect Your Rights with Experienced Legal Representation
For healthcare providers in California, dealing with an FCA investigation can be complicated, and the stakes could not be higher. These cases are often initiated without warning and may lead to severe consequences for your business and reputation.
At the Law Offices of Art Kalantar, we understand the nuances of healthcare fraud defense under the False Claims Act. With decades of experience representing clients in Los Angeles and beyond, our firm is committed to protecting your rights and achieving the best possible outcome in your case.
If you are facing an FCA investigation or need guidance on compliance, contact our office today at 310-773-0001 for a no-cost, initial and confidential consultation. Let us help you defend your practice and your livelihood.
