False Claims Act

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“Beware the Jabberwock, my son! The jaws that bite! The claws that catch!”

– Lewis Carroll: “Jabberwocky,” Through the Looking-Glass, and What Alice Found There (1872)

There is a growing sense of confusion and unease among many federal contractors and grant recipients in these early days of the second Trump administration. In a time when some agencies face dislocation and downsizing (or, as with USAID, effective disbandment), contractors may feel like Alice stepping through the Looking Glass into a world strangely inverted from the one they knew. This shift is especially evident in the administration’s rejection of seemingly all diversity, equity, and inclusion (DEI) policies—long used to prevent discrimination, comply with civil rights laws, and foster inclusive environments in the American workforce.Continue Reading Through the Looking Glass: Shifting DEI Standards Expose Contractors to False Claims Act Risk

Amid the chaos of the past few weeks—sweeping executive orders, relentless cost-cutting, and an air of uncertainty that lingers like smoke after a fire—federal contractors have been left reeling, straining to hear what comes next through the deafening noise. In this storm, predicting the future is as futile as fortune-telling. And yet beneath the shouts of change and upheaval, one truth remains, a whisper through the screams—some things, especially those that serve the government’s interests, are not going anywhere.Continue Reading Whisper Through the Screams: DOJ Commits to False Claims Act Enforcement in 2025

Just how broad is the scope of the False Claims Act (FCA)? That is the basic question posed in Wisconsin Bell, Inc. v. U.S. ex rel. Heath, No. 23-1127. Put more directly, the case addresses whether reimbursement requests under the Schools and Libraries Universal Service Support program—better known as the E-Rate program—are actionable “claims” exposed to liability under the FCA. But when the US Supreme Court hears oral argument next month, the justices will grapple with broader questions with implications far beyond this case: (1) when does the government “provide” money in any transaction or program so that FCA liability attaches; (2) when is an independent government-sponsored enterprise (e.g., Fannie Mae/Freddie Mac) acting as an “agent” of the United States for FCA purposes; and (3) to what extent do those who deal with private entities established or chartered pursuant to federal law need to watch this case to determine their potential exposure under the FCA and its panoply of enforcement mechanisms?Continue Reading Wisconsin Bell: Testing the Elasticity of False Claims Act’s Scope

Johnny, rosin up your bow and play your fiddle hard
’Cause Hell’s broke loose in Georgia and the Devil deals the cards
And if you win, you get this shiny fiddle made of gold
But if you lose the Devil gets your soul
~ The Charlie Daniels Band

Some might say there’s little difference between dealing with the devil and being a federal contractor. And for the unwary or unprepared, that may not be far off. Federal contracting comes with a litany of “fine print” that would make “Old Scratch” proud. However, as most savvy contractors recognize, it’s all hiding in plain sight, with the devil in the details. Take, for example, the cybersecurity requirements found in the Federal Acquisition Regulations (FAR) at 52.204-21 and the Department of Defense (DoD) FAR Supplement (DFARS) at 252.204-7012, -7019, and -7020. These requirements have been the topic of countless articles, trainings, webinars, whole conferences, etc., so it is surprising while simultaneously not surprising that they form the basis of a federal False Claims Act (FCA) claim the Department of Justice (DOJ) recently filed in its complaint in intervention.Continue Reading DOJ Went Down to Georgia: Lessons Learned from Recent Cybersecurity Enforcement Actions

On August 1, 2024, the US Department of Justice (DOJ) Criminal Division introduced its Corporate Whistleblower Awards Pilot Program (Program), which, like a modern-day Western posse, aims to bring justice to the wild frontier of corporate America. The DOJ is enticing anyone willing to saddle up and provide information on corporate outlaws—i.e., those involved in corruption, financial crimes, foreign corruption, bribery, and/or healthcare fraud. In sum, the Program closes the gaps left by existing whistleblower programs and bolsters the DOJ’s efforts to combat corporate crime. For those who decide to ride with it, the DOJ is promising substantial financial rewards—up to 30 percent of the loot recovered from those outlaws—to insiders, whistleblowers, and relators who come forward with information leading to significant criminal or civil forfeiture actions. As the Program unfolds over its three-year pilot period, it will—or should—be closely watched by False Claims Act defense counsel, plaintiff’s counsel, corporate leaders, and potential whistleblowers alike. If successful, it could permanently expand whistleblower incentives and further embolden an already aggressive DOJ (as if more encouragement were needed), signaling a new frontier in corporate governance and accountability in the United States.Continue Reading A New Frontier in Corporate Accountability: The DOJ’s Corporate Whistleblower Awards Pilot Program

Parties litigating False Claims Act (FCA) cases have long struggled with a thorny question around the essential element of scienter (the defendant’s intent, or state of mind): What/how much does a contractor need to know when submitting an invoice for payment for the related claim to be considered knowingly false when made? When that question arises in FCA litigation, a court’s determination of that essential element of scienter/knowledge often pivots on what the judge believes matters more:

(A) The defendant’s subjective belief at the time a claim is made; or

(B) An objective textual reading of what a person may have known or believed when a claim is made.Continue Reading The False Claims Act’s Fuzzy Scienter Element Brought into Sharp Focus

Most experienced contractors have a healthy fear of the various types of fraud claims: False Claims Act, federal and state wire and mail fraud, common law fraud, etc. They know that enforcement authorities are always looking for ways to swing the hammer against a contractor they suspect is fleecing the government. Fraud claims arise when a victim (sometimes the government) contends that the defendant lied about the goods or services offered in order to induce the victim to voluntarily transfer property to the defendant in an exchange. Where the victim parts with much for nothing in return, the fraud analysis is easy—the defendant’s intent to wrongfully steal property or to inflict a pecuniary loss is obvious. But in cases where the victim receives from the defendant goods or services of real value, whether the defendant intended to harm the victim or deprive them of their property becomes a more difficult question.Continue Reading No Harm, No Fraud: The Supreme Court Narrows the Application of the Wire Fraud Statute and Unanimously Overrules the “Right to Control” Theory

Scenario 1: A pharmacy chain hires a value consultant to review its Medicare and Medicaid billing practices for ways to optimize the coding of drug reimbursements to maximize profits. Drugs that had historically been charged for government reimbursement at $1/pill as the “usual and customary price” are now getting coded for reimbursement at $3/pill—a 200% markup that represents a pure profit windfall to the pharmacy chain. Is this a violation of the False Claims Act (FCA)?

Scenario 2: A construction company that has years of experience in federal procurement contracting had never charged the government for reimbursement of several cost items, because the company’s previous CFO did not feel such reimbursement would meet the “reasonableness” requirements of FAR Part 31 (e.g., FAR 31.201-2(a)(1) and 31.201-3). But the company’s new CFO, holding a different interpretation of the reasonableness standards and Cost Accounting Standards (CAS), instructs his program leads to start charging those items for reimbursement in all new and existing contracts. Is this a violation of the FCA?Continue Reading Knowing IS the Battle: Supreme Court to Address the FCA’s Scienter Standard

On May 12, 2021, the Biden administration unveiled a rather expansive executive order intent on “Improving the Nation’s Cybersecurity.” The lengthy and sweeping order is a comprehensive national cybersecurity overhaul. In addition to requiring significant improvements to the cybersecurity posture of the Federal Civilian Executive Branch (FCEB) agencies, the order also prescribes:

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In United States ex rel. Silver v. Omnicare, Inc., et al. (D.N.J. No. 11-cv-01326), a whistleblower relator consistently alleged that certain pharmaceutical service providers have engaged in an illegal kickback arrangement and defrauded the government by offering unreasonably low prices to nursing homes for Medicare Part A patients’ prescription drugs in exchange for the opportunity to provide the same drugs at much higher costs to the nursing homes’ Medicaid and Medicare Part D patients for reimbursement. In a recent Order, the federal district court in New Jersey revived previously dismissed claims and permitted the relator to file a new, and fourth, amended complaint that asserts a new theory of liability to buttress the core kickback scheme allegations. The new complaint asserts that prescription drug event (PDE) data and enrollee encounter data are “claims for payment” under the False Claims Act (FCA)—and that even accurate PDE data can be a “false claim” under the FCA in cases where a pharmacy is alleged to pay kickbacks to its customers.
Continue Reading How the Truth Is False: Accurate Prescription Drug Event Data Can Trigger False Claims Act Liability