What Makes Something a “False” Certification Under the False Claims Act?

United States ex rel. Montcrieff v. Peripheral Vascular Associates – Part III

False Claims Act - Healthcare Qui Tam Attorneys - The Whistleblower Firm

We have all heard the term “false.”  It is something that is ‘not true,’ right?  The False Claims Act, however, does not apply to all falsehoods.

A claim to Medicare may be false under the False Claims Act when the provider falsely certifies that it has complied with all relevant statutes and regulations related to the claim for payment. The certification in question must be a prerequisite to qualifying for the government reimbursement. That means that if a provider makes a false certification, but that certification has no bearing on whether the government would pay the Medicare benefit or not, then it is not actionable fraud under the False Claims Act.  The false certification has to be the qualifying factor behind the provider obtaining the reimbursement. 

That, then, brings us to the difference between false claims under the False Claims Act that are “factually false” compared to ones that are “legally false,” based on false certifications.

  • Factually false claim. A factually false claim involves an inaccurate description of goods or services provided (e.g., a hospital claimed a more complex DRG than the discharge diagnosis, and notes indicate).
  • Legally false claim. A legally false claim is when a provider submits a document that is not true, certifying that it complied with federal law, and that certification is a prerequisite to receiving the government benefits. 

OUR PROMISE Being a healthcare whistleblower can feel like David taking on Goliath. We help level the playing field.

Our law practice is dedicated exclusively to representing healthcare whistleblowers who are willing to take a stand against unscrupulous corporations that are ripping off our government. Whether the fraud involves __________, we pride ourselves on unparalleled level of service, support and legal assistance for our clients.

    Contact Us

    Contact Us

    The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential False Claims Act case falls within our case requirements. IF IT DOES, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential defendants are not necessary at this point, should you feel more comfortable omitting them.) By law, all communications to us are 100% confidential.

    No. of Employees at the Company?
    Please read the following statement and then click "Send Form":

    Any response to your e-mail will be solely to communicate about our possible representation of you under the qui tam provisions of the False Claims Act. All e-mails submitted to us, whether we take your case or not, are 100% confidential. If we do not respond to your e-mail, then you have communicated information which we cannot address because it appears to fall outside of the False Claims Act or our case requirements.