How To File a False Claims Act Claim: Complete Guide

The False Claims Act (FCA) is a cornerstone in the fight against fraud targeting the federal government. Established during the Civil War, it was initially designed to combat widespread misconduct by military contractors supplying defective goods or services.

Over time, the FCA has evolved into a powerful legal mechanism that allows whistleblowers, or private citizens, to report false or fraudulent claims on behalf of the government. These claims often involve misuse of public funds in areas such as healthcare, defense, and federal programs, helping safeguard taxpayer money and hold wrongdoers accountable.

Under the FCA, whistleblowers play a pivotal role in exposing fraud, and their efforts are incentivized through financial rewards and legal protections. Known as qui tam actions, these lawsuits empower individuals with insider knowledge to act on behalf of the government, with the potential to recover significant funds. In return, whistleblowers may receive a percentage of the recovered amount, sometimes amounting to millions of dollars.

This guide will detail the process of how to file a False Claims Act claim, the types of evidence required to support these cases, and the benefits available to those who come forward to report fraud.

What Is a False Claims Act Claim?

The U.S. Department of Justice defines the False Claims Act as a response to defense contractor fraud which was first legislated during the American Civil War in 1863. The FCA stipulates a penalty of three times the government’s damages for anyone who submits or causes others to submit false claims with full knowledge to the government. The same liability applies in cases when a person avoids a required government payment or files a false claim using false record material. A person also violates the FCA if they participate in a conspiracy that contributes to these activities.

The Act also allows private citizens to file lawsuits on behalf of the government in what are known as “qui tam” actions, enabling whistleblowers to share in the government’s recovery if the case is successful.

The False Claims Law is a law that punishes people or companies for lying to the government to get the money they don’t deserve. For example, imagine a company sending fake bills to the government for work they didn’t do. The FCA says they must pay back the money, plus extra as a penalty. If they lie on purpose or try to cover it up, the penalties get even worse.

Here’s the cool part: regular people, like you or me, who see this fraud happening can help the government by filing a lawsuit on its behalf. If their case helps recover money, they get rewarded with a portion of what’s recovered. It’s like being a detective who not only stops the bad guys but also gets paid for it! For example, if a hospital pretends to treat patients it never saw and bills the government, an employee who knows about this could use the FCA to report it and help stop the fraud.

For more details on the False Claims Act, read this comprehensive False Claims guide.

What Are the Steps in Filing a False Claims Act Claim?

Filing a claim under the FCA is a multi-step process that requires careful preparation and legal expertise. Each step plays a crucial role in building a strong case against fraud.

1. Find a False Claims Act Lawyer

The most important first step is consulting an experienced False Claims Act lawyer, as FCA cases are complex and require specialized legal knowledge. A qualified attorney will:

• Evaluate Your Evidence: They’ll review any documents, emails, financial records, or other proof you have to determine if it’s enough to show a false or fraudulent claim was made to the government.
• Assess Scienter: This means ensuring that the defendant knowingly committed fraud. Under the FCA, fraud must involve actual knowledge, reckless disregard, or deliberate ignorance of the truth. For example, if a contractor submits inflated invoices for work they didn’t complete, their intention to deceive the government must be evident.

A skilled False Claims Act lawyer can also help you determine whether your claim meets the necessary legal standards, assist with gathering additional evidence, and ensure your rights as a whistleblower are protected. Their guidance increases the likelihood of government intervention, which often strengthens the case and leads to greater recoveries.

2. Inform the Defrauded Agency

Notifying the government agency involved in the fraud is a vital step in filing an FCA claim. This step ensures that the appropriate federal authority is aware of the fraudulent activity and can initiate an investigation to protect public funds.

Examples of Agencies to Notify:

• Healthcare Fraud: Notify the Department of Health and Human Services (HHS) if the fraud involves Medicare, Medicaid, or other healthcare programs.
• Defense Contract Fraud: Report cases involving military or defense spending to the Department of Defense (DOD) or coordinate with the Federal Bureau of Investigation (FBI).

Why Timely Notification Matters:

• Initiates Investigations: Early notification allows the government to begin collecting evidence and interviewing witnesses.
• Strengthens the Case: Collaborating with the appropriate agency ensures thorough review and validation of your claims.
• Demonstrates Credibility: Prompt action shows your commitment to assisting the government in addressing fraudulent practices.

3. Make a Disclosure

To initiate an FCA claim, whistleblowers must submit a comprehensive disclosure statement to the DOJ. This disclosure is a critical document that serves as the foundation of your claim, detailing the fraudulent activity and providing supporting evidence to substantiate your allegations.

What to Include in the Disclosure:

• Detailed Description of Fraud: Clearly outline how the fraud occurred, including who was involved, the timeline, and the methods used to submit false or fraudulent claims.
• Supporting Evidence: Attach relevant documentation, such as:
  • Invoices that show overbilling or false charges.
  • Emails or internal communications that reveal intent or knowledge of the fraud.
  • Contracts that were knowingly breached or altered to deceive the government.
  • Financial Records that highlight discrepancies or misuse of funds.
• Impact on Government Funds: Specify the amount of money lost or at risk due to the fraudulent activity.

Why the Disclosure Is Critical:

• Confidentiality: The document is submitted under seal, meaning it is not made public while the DOJ investigates the claim.
• Triggers Investigation: A thorough disclosure enables the DOJ to evaluate the fraud and decide whether to intervene in the case.
• Establishes Credibility: A well-prepared statement demonstrates the whistleblower’s seriousness and strengthens the case’s validity.

4. Determine the Statute of Limitations

Understanding the statute of limitations under the FCA is crucial to ensuring your claim is filed on time. The FCA imposes specific deadlines to prevent delays in reporting fraud against the federal government. Filing outside these timeframes can result in the dismissal of your claim, regardless of its merit.

Key Deadlines:

• Six-Year Rule: You must file your claim within six years of the date the fraud occurred. For example, if fraudulent billing to Medicare took place in 2017, you have until 2023 to file your claim.
• Three-Year Rule (Knowledge-Based): If the fraud wasn’t immediately discovered, the clock starts ticking from the date the government became aware of the fraud. In this case, you must file within three years of discovery, but no later than ten years after the violation occurred.
  • Example: If the fraud occurred in 2015 but wasn’t uncovered until 2020, you have until 2023 to file under this rule.

Why Timing Matters:

• Dismissal Risk: Filing outside the applicable timeframe will likely lead to the court dismissing your case, regardless of the evidence presented.
• Preservation of Evidence: Timely filing ensures that key evidence, such as documents and witness testimony, remains available and credible.
• Government Intervention: Filing within the statute of limitations gives the government adequate time to evaluate and potentially intervene in the case.

5. File the Lawsuit Under Seal

Filing the qui tam complaint under seal is a critical step in the FCA process. This requirement ensures the case remains confidential, allowing the DOJ to thoroughly investigate the allegations without alerting the defendants. This confidentiality protects the integrity of the case and gives the government a chance to gather additional evidence.

Key Steps in Filing Under Seal:

• File in Federal Court: The lawsuit must be submitted to a United States District Court. The filing includes a detailed complaint and a disclosure statement that outlines the fraud and provides supporting evidence.
• Remain Under Seal: The case is initially sealed for a minimum of 60 days, during which the DOJ evaluates the claim and decides whether to intervene. This period ensures the government can act without tipping off the defendants, which could lead to the destruction of evidence or other evasive actions.

Extensions of the Seal Period:

• The DOJ may request extensions beyond the initial 60 days if the case involves complex fraud schemes or multiple defendants. However, these extensions require strong justification and approval from the court.
  • Example: In cases involving widespread fraud affecting multiple government programs, the DOJ may need more time to coordinate with various agencies and gather evidence.

Why Filing Under Seal Is Important:

• Protects Confidentiality: Keeping the case sealed prevents the defendant from learning about the investigation prematurely, which could compromise the government’s efforts.
• Encourages Government Intervention: The confidential period gives the DOJ an opportunity to assess the claim’s validity and decide whether to intervene, which can significantly enhance the case’s chances of success.
• Supports Whistleblower Protections: Sealing the case helps protect the whistleblower from potential retaliation during the early stages of the investigation.

6. Government Evaluates the Case

Once the qui tam complaint is filed under seal, the DOJ evaluates the case, and the government decides whether to intervene. This decision is crucial, as government intervention often significantly strengthens the case. This step is critical, as the government’s involvement often strengthens the case and increases the likelihood of a successful outcome.

Outcomes of the Government’s Evaluation:

• Intervention: If the DOJ intervenes, it takes control of the prosecution, significantly increasing the likelihood of success in a False Claims Act case due to the government’s resources and expertise. This significantly boosts the case’s credibility and resources, as the government brings its investigative and legal expertise to the table.
  • Example: In cases involving complex fraud against Medicare or defense contracts, government intervention often results in substantial recoveries and penalties.
• No Intervention: If the government declines to intervene, the whistleblower (known as the relator) has the option to proceed independently. While this allows the case to move forward, the burden of proof rests solely on the whistleblower and their legal team, making it more challenging to win.
  • Without the DOJ’s resources, pursuing the case requires robust evidence and a skilled legal strategy.

Key Considerations:

• DOJ’s Decision Is Not Final: Even if the government initially chooses not to intervene, it may later join the case if new evidence emerges.
• Collaboration With the DOJ: During the evaluation process, the whistleblower’s attorney collaborates with government officials, providing additional evidence or clarification to strengthen the case.
• Confidentiality: The case remains sealed while the DOJ decides, ensuring confidentiality for both the whistleblower and the investigation.

7. Government Files the Case in Federal Court

If the DOJ intervenes, the case proceeds in federal court. The government may seek civil penalties, restitution, and triple damages against the defendants.

For help with each of these steps, consult qui tam complaint attorneys to guide you through the process.

How Are These Steps Different From Filing Other Cases?

Filing an FCA claim differs from other lawsuits in several ways:

• Confidential Filing: FCA claims are filed under seal to protect the investigation.
• Government Involvement: The government plays a key role in investigating and potentially prosecuting the case.
• Qui Tam Provisions: Unique to the FCA, private citizens can sue on the government’s behalf and share in the recovered funds.

What Evidence Does My False Claims Act Claim Need?

To build a strong False Claims Act case, you must provide material evidence that proves the fraud occurred. Examples include:

1. Documentation: Invoices, contracts, or emails showing false or fraudulent claims
2. Witness Testimony: Statements from individuals with firsthand knowledge of the fraud
3. Scienter Proof: Evidence showing the defendant acted knowingly or recklessly

Strong evidence increases the likelihood that the government investigates and intervenes in your case.

What Damages Do the Guilty Parties Have To Pay?

Defendants in False Claims Act cases face severe penalties, including:

• Civil Penalties: Up to $25,000 per fraudulent claim
• Treble Damages: Triple the amount of the government’s losses
• Legal Costs: Reimbursement of court and attorney fees

These penalties serve as a deterrent against fraud and ensure the government’s recovery of stolen funds.

What Rewards or Compensation Are You Owed?

Whistleblowers in FCA cases are entitled to significant rewards, such as:

• Financial Rewards: Qui tam whistleblowers receive 15% to 30% of the funds recovered, which can amount to millions in large cases.
• Job Protections: Whistleblowers are protected from retaliation, including termination or demotion.
• Confidentiality: Laws ensure whistleblowers’ identities remain anonymous during investigations.

Start your claim with a Free Case Assessment to understand your potential rewards and protections.

Where Can You Get Help With Filing a False Claims Act Claim?

Filing a False Claims Act claim is complex and requires professional legal support. A skilled attorney can:

• Assess Your Case: Determine if your evidence supports a false claims procedure
• Guide Filing: Help you file a qui tam complaint under seal
• Advocate for Rewards: Ensure you receive your share of the government’s recovery
• Protect Your Rights: Defend you against retaliation or legal challenges

Learn more about how attorneys can help here.

Conclusion

The Federal False Claims Act is a powerful tool for exposing fraud and recovering stolen government funds. By understanding the false claims procedure and working with an experienced attorney, you can successfully navigate the process, protect your rights, and secure significant rewards.

If you’re considering filing a claim, reach out to a trusted False Claims Act lawyer or explore this False Claims guide for more information. With the right guidance, you can make a meaningful difference in the fight against fraud.