Over the past six months, the Trump Administration has placed significant emphasis on combatting “waste, fraud, and abuse” in federally funded, state-administered benefits programs. The Medicaid program occupies center stage in those efforts. Among other things, the Trump Administration has released provider-level Medicaid spending data for the first time, restructured and reformed U.S. Department of Justice (DOJ) processes for fraud enforcement, and placed pressure on state regulators to ramp up their anti-fraud efforts.
Providers, Medicaid managed care organizations, and other Medicaid fund recipients now operate under heightened scrutiny from federal and state regulators. These developments, as we explain below, create an increased risk of False Claims Act (FCA) actions by both the government and private qui tam relators.
The FCA is the federal government’s primary civil fraud statute for recovering losses tied to allegedly false claims submitted to the government. In broad terms, the FCA prohibits knowingly submitting false claims for payment or improperly retaining obligations, including identified overpayments, from the government. The statute carries substantial consequences, including treble damages and per-claim civil penalties.
The FCA also allows private individuals, known as relators, to bring qui tam suits on the government’s behalf and share in any recovery. That means FCA exposure can arise not only from a government-initiated investigation, but also from...
In a desperate attempt to sway an election just days before voters head to the polls, DSA-backed candidate Jibreel Jalloh and his supporters have chosen to spread false allegations involving my fa...