A Massachusetts health care company has agreed to a $4.625 million settlement in a lawsuit involving allegations that the company violated the False Claims Act. The settlement includes a resolution for allegations made by whistleblowers involving the qui tam provisions of the act.
What is the False Claims Act and what did the company do to violate it?
The False Claims Act
The False Claims Act is a federal statute enacted in 1863. The FCA makes people who submit claims they know are false to the government liable for triple the government’s damages and a penalty for each false claim.
The government may pursue violators. The FCA’s qui tam provisions also allow private citizens to file lawsuits on the government’s behalf. Private citizens who win qui tam lawsuits may receive a portion of the government’s recovery.
Violations of the False Claims Act
Whistleblowers sued the health care company for submitting reimbursement claims to MassHealth while violating licensure and supervision of staff regulations. These violations made the company ineligible to receive reimbursement for services from MassHealth. The company’s misrepresentation of its eligibility for reimbursement from the state may constitute a violation of the False Claims Act.
Former employees of the company brought the qui tam suit that resulted in an investigation by the state attorney general’s Medicaid fraud division. The former employees also allege retaliation against whistleblowers by the company.
Employees and other insiders who report False Claims Act violations may bring lawsuits and receive whistleblower protections from retaliation. Many government investigations and settlements related to the False Claims Act begin as qui tam lawsuits brought by whistleblowers.