Detroit False Claims Act & Qui Tam Defense Lawyers

Experienced Legal Defense for Healthcare Fraud, False Claims Act and Qui Tam Investigations in the Detroit Area

Dallas-based health care law defense firm The Criminal Defense Firm deals with cases involving regulatory compliance, corporate structuring, litigation, government investigations, and criminal defense. Our diverse and tested group of attorneys includes the former Chief Health Care Fraud Coordinator at the U.S. Attorney’s Office, former senior Department of Justice trial attorneys, and former lead prosecutors of the elite Medicare Fraud Strike Force. Our lawyers have years of relevant experience and studied at some of the nation’s best law schools, such as Harvard and Yale.We serve clients in Detroit as well as throughout the state of Michigan.

The The Criminal Defense Firm has substantial knowledge regarding the practice of advising and defending clients in False Claims Act investigations. Our nationally acclaimed Health Care Fraud Defense Group is led by a strong experienced legal team.

Detroit, Michigan False Claims Act Investigations

In the United States, there are nine areas where the federal government has established special forces tasked with surveillance, inspection, and prosecution of violations related to the False Claims Act. Of these nine areas, Detroit is a focus for government prosecution, and health care organizations and professionals need to be aware of the ever-growing frequency of prosecutions occurring within the community. Prosecutions are being organized and implemented by Health Care Fraud Prevention and Enforcement Action Team (HEAT). They are a systemized federal task force whose members are from the Department of Justice (DOJ), Department of Health and Human Services (HHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and various government agencies.

False Claims Act Explained

The False Claims Act is responsible for holding organizations, individuals, corporations, and government contractors liable for submitting or knowingly causing the submission of fraudulent or false claims with the intent of obtaining approval or payment from the government. The False Claims Act is a mandate that is applicable to any business or individual that engages with, and is reimbursed by, the United States government either directly or indirectly. Failing to satisfy a legal requirement by knowingly making a submission of false or inaccurate claims incurs liability under the False Claim Act by default.

It’s important that you understand what ‘knowingly” means according to the law. It means that you knew or should have known that whatever happened could be addressed as a violation of the False Claims Act. For instance, if you’re a doctor, it is presumed that you knew or that you should have known if your medical coding clerk used an obsolete code. Because of due diligence, it is your job to know and to ensure that the clerk is aware of all recent updates.

Civil & Criminal Liability in Detroit, Michigan

The investigation process under the False Claims Act in Detroit can create various challenges for businesses and individuals. Under the statute, penalties can be either civil or criminal; it can be unclear at the start of a case whether the government will pursue the case through civil channels or seek to have criminal charges held against the business owner. The following is a breakdown of civil and criminal liabilities that your may face:

• Civil Liability: Any party that knowingly causes or submits a false or fraudulent claim to the United States government may be assessed triple the amount of damages and a penalty of up to $11,000 per false claim.
• Criminal Liability: A five-year prison sentence and fines are the penalties for filing a false claim. The type of charges, meaning whether you are facing a misdemeanor or felony, determines the fine. It is also dependent upon if you are a person or a business. Federal felony convictions may be assessed for a fine of $250,000 (individuals) or $500,000 (companies). For each misdemeanor conviction, a party may be assessed $100,000 (individuals) or $200,000 (companies). Note that these fines will be accrued per claim.

What Is a Qui Tam Lawsuit?

In many cases, the government may not always initiate a False Claims Act investigation. Instead, they are often started by former employees or competitors. There is a provision within the False Claims Act that allows private citizens (qui tam relator) to file a qui tam lawsuit to recover money on behalf of the federal government. Qui tam is short for the Latin phrase: “he who sues for the king and himself.” It is similar to accusing a business or individual of committing fraud against the federal government under the False Claims Act. In practice, this how a qui tam lawsuit operates:

The plaintiff (the qui tam relator) files a complaint against the defendant(s) (an individual, a business, or both). The complaint is filed with the U.S. District Court for the Eastern District of Michigan. The court’s clerk files Qui tams under seal. This protects the anonymity of the plaintiff. Copies are only provided to specific government officials and the presiding judge. Regular six-month extensions are permitted to ensure the case is kept sealed. This process also allows sufficient time for the federal government to investigate the case.

The government screens the case once they receive a copy of the qui tam. The government has the option to reject unsubstantiated claims. If the claim proves to warrant an investigation, the government will seek the assistance of federal law enforcement agencies such as the FBI, the OIG, the DEA, and other agencies. Investigations are conducted via subpoenas that require the party accused to submit corporate, financial, business, and communication records specifically requested by the government.

During this time period, the government and your health care fraud lawyers undergo negotiations. Several months may pass before the government evaluates the qui tam. Depending on the investigation and even more time may pass before the matter is fully settled. Once the submitted records are reviewed and negotiated with your health care fraud defense attorney, the government will either rule a decision in favor of the plaintiff and intervene or determine abstention leaving the relator to pursue the case on their own.

Cases in which the government intervenes must be submitted through an approval process. This process involves the Department of Justice’s Washington D.C. headquarters. The Department of Justice often amends the complaint to include additional causes of action such as alleging that you have violated the Anti-Kickback Act and the Truth in Negotiation Act.

If found to be liable, individuals and companies accused of violating the False Claims Act in the qui tam lawsuit could be required to pay up to three times the losses paid out by the government in addition to sanctions of up to $11,000 per claim. Qui tam plaintiffs are allowed an incentive by law. They are allowed to retain up to 25 percent of any amount collected should the government intervene in the litigation. If the plaintiffs collect on their own, without the government negotiation, they may collect up to 30 percent.

Proven Defense Strategies

At The Criminal Defense Firm, our experienced attorneys have successfully resolved False Claims Acts throughout the United States. Our attorneys have extensive knowledge of False Claims Act investigations and defense strategies that allow us to identify the difference between human error and liability. In many cases, it is often a fine line that requires negotiation, attention to detail, and established industry experience. Our guiding principles follow.

• No criminal charges when possible. Our priority is to avoid criminal charges for our clients with any False Claims Act cases. Our extensive knowledge of federal health care fraud defense work gives us the insight to determine whether the investigation is civil or criminal, the government’s intentions, and how to resolve the matter effectively. We possess the capabilities to inform our clients within the first few days, on average, the reason for the case, what exposure is available, and what the government intends to do.
• No government intervention. Disgruntled ex-employees or competitors with malicious intentions file many False Claims Act cases; as such, we will challenge their allegations, question their evidence, ruthlessly dismantle their story, and cast doubt on their credibility. Tactics such as these allow us to prove to the government that the accusations are worthless and undeserving of government assistance and intervention.
• Favorable settlement. In many of our previous civil liability cases, we have been able to negotiate government restitution requests to only a fraction of the demanded amount. To this date, none of the False Claims Act cases handled by our group have resulted in any of our clients having to close or shut down their business.

The Criminal Defense Firm

The attorneys of The Criminal Defense Firm have defended physicians, practice owners, physician-owned entities, toxicology laboratories, device companies, pharmacies, service management organizations, health care marketing companies, hospitals, and many others in False Claims Act, qui tam lawsuits, Stark Law, Anti-Kickback, Medicare, Tricare, and DOL investigations.

• Defense of Medicare laboratory against investigations by the Department of Justice and the U.S. Attorney’s Office for alleged Medicare fraud.
  Result: No civil or criminal liability.

• Defense of a health care services company against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged False Claims Act and Stark Law violations.
  Result: No civil or criminal liability.

• Defense of Medicare laboratory against investigations by the Department of Health and Human Services and the Office of Inspector General for alleged health care fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating health care company against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of health care marketing company against an investigation by the Office of Inspector General for alleged False Claims Act and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a laboratory against an investigation by various branches of the federal government for alleged fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged False Claims Act violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Defense for alleged Tricare fraud.
  Result: No civil or criminal liability.

• Defense of a physician-owned entity against an investigation by the Department of Justice for alleged Medicare fraud.
  Result: No civil or criminal liability.

• Defense of physician-owned entity against an investigation by the Department of Health and Human Services for alleged Stark Law violations.
  Result: No civil or criminal liability.

• Defense of health care management organization against an investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare fraud.
  Result: No civil or criminal liability.

• Defense of nationally operating laboratory against an investigation by the Office of Inspector General for alleged fraud.
  Result: No civil or criminal liability.

Medicare Fraud Defense Attorneys Serving Detroit

We are available every day of the year. You can call us or complete our contact form or email us directly.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. The Criminal Defense Firm is a Texas firm with headquarters in Dallas.