Healthcare Fraud Lawyer Blog
Under the False Claims Act, an individual or agency can be held liable if they knowingly submit a false claim to the government, or cause the submission of a false claim. When individuals see these wrongdoings and false claims being made, they can pursue a whistleblower lawsuit to correct the wrong. Like any lawsuit though, they will need to provide certain proof before a lawsuit can proceed. The two elements of proof in these lawsuits are that the claim must have been made knowingly, and it must have been false or fraudulent.
Knowingly Making a False Claim
Defendants cannot only be held liable for submitting a false claim, they can also be held liable if they intended to submit one, even if they never did. However, the false claim must be made by a person with full intention of defrauding the government. Simple negligence or innocent errors are not enough to hold a person liable for the fraudulent act.
While negligence is not enough to hold a person liable, recklessness sometimes is. Recklessness is not necessarily intentional, but it is considered to be more serious than negligence. For example, if a doctor billed Medicare for working 24 hours or more during a day, the doctor may be held liable for failing to review the bills submitted on his or her behalf. This is true even if the doctor had no intention to make a false claim.
Proving a person had knowledge that a claim was false is often challenging. Those liable rarely confess to making a false claim. However, emails and paper trails are often used to prove a person had knowledge to make a fraudulent claim.
Making a Fraudulent Claim
Unlike the term ‘knowingly,’ the term ‘false’ or ‘fraudulent’ is not outlined in the False Claims Act. When the definition of this term becomes an issue in a whistleblower lawsuit, the court will determine if the alleged fraudulent act was a reasonable interpretation of the law. In many cases, the courts have determined that a claim must be false under all reasonable interpretations.
The fact that there is no concrete definition of fraudulent or false in the statute can become an issue in whistleblower lawsuits. A defendant that has an understanding of the law might argue an interpretation of the law the court deems reasonable and therefore, not be held liable.
Have You Noticed Wrongdoing? Call Our California Qui Tam Attorneys
When a person sees wrongdoing that defrauds the government, that person has an obligation to do the right thing and blow the whistle. However, that is unfortunately not enough. As a whistleblower you will need to prove your claim, which is often challenging. At Willoughby Brod, LLP, our San Francisco qui tam attorneys can guide you through the complicated process of blowing the whistle. We will help you collect evidence to serve as proof, so you have the best chance of a successful outcome. If you want to blow the whistle, call us at (800) 427-7020 for your free case evaluation so we can advise on your options.
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