A successful False Claims Act claim must show that the defendant submitted a false claim or statement “knowingly.” The “knowing” element of the claim — known as the scienter prong — depends on whether the defendant actually knew that the claim or statement was incorrect, or recklessly disregarded the facts or legal requirements that rendered the claim “false.”
Government regulations — for example, those that govern when and how programs including Medicare and Medicaid will pay for the item or service being “claimed”—can be incredibly complex and difficult to understand. The same can be true for provisions in government contracts, grant programs, and the like.
When the ground rules are unclear, how does the company submitting a claim for payment “know” that its claim may be false under the FCA?
The FCA defines “knowing” as when a person (1) had “actual knowledge of the information;” (2) acted “in deliberate ignorance of the truth or falsity of the information;” or (3) acted “in reckless disregard of the truth or falsity of the information.” It doesn’t require a “specific intent to defraud,” just that the person knew or deliberately ignored, or recklessly disregarded the relevant information.
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