Be Wary, But not Fearful, of False Claims Act Allegations

Be Wary, But not Fearful, of False Claims Act Allegations

One of my favorite things to do is help clients extricate themselves from a False Claims Act investigation. I like it because it’s intellectually challenging, and few things are more rewarding than keeping an organization from having to pay large sums of money.

Longtime readers know that False Claims Act investigations are filed under seal. The government then investigates to determine whether it wishes to intervene in the case.

During the investigative period, which is statutorily supposed to be completed within 60 days, but in reality, takes years, the case remains under seal. The public won’t, and really can’t, learn about it.

Whenever the government makes its intervention decision – whether that decision is to intervene, decline intervention, intervene to dismiss, or kick the can down the road – the case is unsealed and becomes public.

I have been involved in over 50 False Claims Act cases. For the first two decades, I would have said you could be quite confident that the government would notify you of its intervention decision before the unsealing, so you wouldn’t be surprised. But something has changed, and I don’t think that is still true.

This has important implications. The minute the government makes its intervention decision, the court file is publicly available. It’s quite common for reporters, law firms, and others to watch court dockets. If you haven’t received a heads-up from the government about their decision, you can find yourself in a situation where you’re getting a cold call from a reporter about the case. While that’s not exactly what happened to me last week, it could have, because I have a case for which we got the good news of the government’s decision to decline, but we discovered it without hearing from the government.

Now, I realize this may sound like a practice tip for lawyers, and you may be thinking “I am not a lawyer. Why is David wasting my time with this?” But this brings me to a second important point. There’s nothing magical about being a lawyer. Non-lawyers can and do teach smart lawyers a lot. Good lawyers listen carefully to their clients. You can help your lawyer, and yourself, if you remind your counsel that they should set up a docket watch whenever you have a False Claims Act case. And if your lawyer bristles whenever you offer suggestions, or acts like you are invading their turf, think about getting a new lawyer. 

False Claims Act cases can be scary. The amount of dollars involved is potentially enormous. But my third and final point is that in about three-quarters of the False Claims Act cases where I’ve been involved, the case resolves without any money changing hands. There is discussion this week from Knicole Emanuel and Mary Inman about some significant false claims settlements, but that shouldn’t cause you to assume that the moment you get a civil investigative demand or a visit from government agents, it means your organization will be writing a big check.

If your counsel is thoughtful and creative, and you’re willing to be patient, with the regulatory environment as unclear as it often is, the case may one day simply go away. And I will note that in recent times, resolution has often been just as silent as the unsealing decision was last week.

You can’t assume that you will ever hear that the case has been closed. There’s a very real possibility that it will just go quietly into the night.

Facebook
Twitter
LinkedIn

David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24