Houston, TX asked in Health Care Law for Texas

Q: Does the Health Care Fraud Act fall under the umbrella of the False Claims Act or are they two completely separate laws?

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1 Lawyer Answer
Ryan P. Morrison
Ryan P. Morrison
  • Health Care Law Lawyer
  • Boston, MA

A: My expertise is in the False Claims Act, but as I understand it, the Health Care Fraud Act is a criminal statute, calling for criminal fines and/or prison sentences for certain conduct that defrauds government health care programs. Think about it this way: the Health Care Fraud Act is when the government is acting like the police, or like a regulator -- there just happens to be specific penalties when you commit crimes against health care programs.

In contrast, the False Claims Act is a civil statute -- it's the government acting like a consumer. When the government suffers some form of financial harm, like if a doctor submitted a claim for payment to Medicare for services he or she didn't provide, the False Claims Act is one way in which the government can get its money back (with up to three times' damages). The False Claims Act covers many forms of fraud against government health care programs, but it also covers many other forms of fraud, including false claims on defense contracts, and underreporting amounts of customs duties owed.

The False Claims Act is also different in that it's enforceable by people other than the government: under its "qui tam" provision, it empowers private persons to sue on the government's behalf (and to collect an award of 15%-30% any resulting recovery). The government gets the opportunity to take over the case (by intervening, after an initial investigation period), but even if the government declines to intervene, a private person bringing the suit retains the option to pursue it him or herself.

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