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        <title><![CDATA[healthcare enforcement action - Conaway & Strickler]]></title>
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                <title><![CDATA[False Claims Act – Zafirov 11th Circuit Ruling Coming Soon]]></title>
                <link>https://www.conawayandstrickler.com/blog/false-claims-act/</link>
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                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Sat, 06 Jun 2026 20:58:10 GMT</pubDate>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Federal Crimes]]></category>
                
                    <category><![CDATA[Federal Offenses]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                
                    <category><![CDATA[healthcare enforcement action]]></category>
                
                    <category><![CDATA[healthcare fraud]]></category>
                
                    <category><![CDATA[healthcare fraud defense]]></category>
                
                    <category><![CDATA[healthcare professional defense]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                    <category><![CDATA[Qui Tam Litigation lawyers]]></category>
                
                
                
                <description><![CDATA[<p>The Eleventh Circuit is currently considering the constitutionality of the False Claims Act’s Qui Tam Provisions. The Whistleblower on Trial: The History and Uncertain Future of Zafirov v. Florida Medical For over a century, the False Claims Act (FCA) has been the federal government’s most potent weapon against fraud. At its core sits the qui&hellip;</p>
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                <content:encoded><![CDATA[
<p>The Eleventh Circuit is currently considering the constitutionality of the<a href="https://www.justice.gov/civil/false-claims-act" id="https://www.justice.gov/civil/false-claims-act"> False Claims Act’</a>s Qui Tam Provisions.  </p>



<p></p>



<p><strong>The Whistleblower on Trial: The History and Uncertain Future of <em>Zafirov v. Florida Medical</em></strong></p>



<p><br>For over a century, the False Claims Act (FCA) has been the federal government’s most potent weapon against fraud. At its core sits the <strong>qui tam</strong> provision—a mechanism allowing private citizens (called “relators”) to sue companies on behalf of the government and pocket a portion of the recovered funds.<br></p>



<p>But a case in Florida has put the entire multi-billion-dollar whistleblower framework on trial. The case is <a href="https://www.uschamber.com/cases/false-claims-act/zafirov-v-florida-medical-associates-llc-2" id="https://www.uschamber.com/cases/false-claims-act/zafirov-v-florida-medical-associates-llc-2"><em>United States ex rel. Zafirov v. Florida Medical Associates, LLC</em>.</a> After lower-court rulings and tense appellate arguments in December 2025, the legal and healthcare worlds are anxiously awaiting to see how the Eleventh Circuit Court of Appeals will rule.<br><br><strong>The History of this False Claims Act suit: How We Got Here</strong></p>



<p><br>The story began when Dr. Clarissa Zafirov, a physician in Florida, alleged that her employer and other defendants engaged in systemic <a href="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/health-care-fraud/" id="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/health-care-fraud/">Medicare fraud</a> by misrepresenting patient conditions to pad federal reimbursements. The U.S. government chose not to intervene, leaving Dr. Zafirov to spearhead the complex litigation herself.<br></p>



<p>The defendants, however, didn’t just fight the fraud allegations; they attacked the constitutional foundation of the lawsuit. In September 2024, U.S. District Judge Kathryn Kimball Mizelle dropped a bombshell by dismissing Zafirov’s suit. She didn’t rule on whether fraud occurred. Instead, she ruled that the False Claims Act’s qui tam provisions are unconstitutional.<br></p>



<p><strong>The Article II Battleground</strong></p>



<p><br>Judge Mizelle’s ruling hinged on the <a href="https://constitution.congress.gov/browse/essay/artII-S2-C2-3-1/ALDE_00013092/" id="https://constitution.congress.gov/browse/essay/artII-S2-C2-3-1/ALDE_00013092/">Appointments Clause of Article II </a>of the U.S. Constitution.<br><code>Is a Whistleblower an "Officer of the United States"? ├── YES ──> Must be appointed by the President, Courts, or Dept. Head. (FCA Fails) └── NO ──> Private citizen pursuing a claim. (FCA Succeeds)</code></p>



<p><br>Judge Mizelle argued that because a relator wields significant executive power—conducting civil litigation in the name of the United States to vindicate public rights—they act as an “Officer of the United States.” Because Dr. Zafirov appointed herself to this role by simply filing a complaint, her status bypassed constitutional appointment protocols.  <em>“Zafirov has determined which defendants to sue, which theories to raise, which motions to file, and which evidence to obtain… Yet no one… appointed Zafirov to the office of relator. Instead… Zafirov appointed herself. This she may not do.”</em><br>— <strong><a href="https://ecf.flmd.uscourts.gov/cgi-bin/show_public_doc?2019-01236-346-8-cv" id="https://ecf.flmd.uscourts.gov/cgi-bin/show_public_doc?2019-01236-346-8-cv">Judge Kathryn Kimball Mizelle</a></strong><br></p>



<p>While decades of judicial precedent across the country had uniformly rejected this argument, Judge Mizelle’s ruling breathed real life into a legal theory previously sparked by Supreme Court Justice Clarence Thomas in a 2023 dissenting opinion (<em>U.S. ex rel. Polansky</em>), where Justices Kavanaugh and Barrett also expressed interest in reviewing the issue.<br><br><strong>The Eleventh Circuit Showdown</strong></p>



<p> <br>The Department of Justice and Dr. Zafirov promptly appealed, leading to highly anticipated <a href="https://www.ca11.uscourts.gov/oral-argument-recordings?field_oar_case_name_value=zafirov&field_oral_argument_date_value%5Bmin%5D=&field_oral_argument_date_value%5Bmax%5D=" id="https://www.ca11.uscourts.gov/oral-argument-recordings?field_oar_case_name_value=zafirov&field_oral_argument_date_value%5Bmin%5D=&field_oral_argument_date_value%5Bmax%5D=">oral arguments </a>before a three-judge panel of the Eleventh Circuit on December 12, 2025.<br></p>



<p>The panel –  Circuit Judges Elizabeth L. Branch, Robert J. Luck, and Senior District Judge Federico A. Moreno—focused intensely on the concept of control.</p>



<p><br>The arguments were mainly over two competing perspectives:<br></p>



<p>1. The Government’s and Relator’s Defense<br>The DOJ shifted its strategy slightly at oral arguments, focusing heavily on the “continuing position” prong of officer status. They argued that an “officer” must occupy a permanent, continuous government seat (like the Secretary of State). A whistleblower is a temporary, self-interested private actor whose role dissolves when the case ends. Furthermore, they argued the government retains ultimate control because it can step in and dismiss or settle the case at any time.<br></p>



<p>2. The Defense and Amici Pushback<br>Attorneys for Florida Medical and supporting business groups argued that when the government declines to intervene (which occurs in roughly 80% of FCA cases), the relator is entirely “in the driver’s seat.” They exercise massive, unaccountable federal authority to issue subpoenas, freeze corporate assets, and force massive settlements without answering to the President.<br><br><strong>Prediction: How Might the 11th Circuit Rule?</strong></p>



<p><br>Predicting appellate outcomes is tricky, but the panel’s questioning in December 2025 offered some clues.  The judges did not treat the constitutionality of the FCA as a settled matter. They repeatedly pressed the DOJ on why Justice Thomas’s strict separation-of-powers logic was wrong.<br></p>



<p>The court essentially faces three paths:<br><br>1) <strong>Reverse the Dismissal</strong> <em>(Uphold the FCA)</em><br>The court aligns with decades of historical practice and other circuits (like the Sixth Circuit’s January 2026 ruling), finding that private bounty-hunters are not public “officers.”  Therefore it would remain business as usual. Whistleblower cases proceed normally in Florida, Georgia, and Alabama.<br></p>



<p>2) <strong>Affirm the Dismissal</strong> <em>(Strike down Qui Tam)</em><br>The panel adopts Judge Mizelle’s and Justice Thomas’s strict textualist view that prosecuting public fraud is an exclusively executive function that cannot be outsourced to unappointed citizens.  This would create Immediate chaos. Hundreds of pending qui tam cases in the Southeast would face dismissal, crippling a primary source of federal fraud recovery.</p>



<p><br>3) <strong>The Middle Ground</strong> <em>(Narrow Procedural Fix)</em><br>The court rules that qui tam actions are only unconstitutional <em>if</em> the government completely declines to intervene, or suggests a fix where the DOJ must sign off on major litigation steps.  A logistical headache for the DOJ, which would be forced to actively micromanage cases it initially wanted no part of.</p>



<p><br><strong>The Verdict on the Horizon</strong></p>



<p><br>Given the conservative, textualist leanings of the Eleventh Circuit panel, an affirmance (ruling the qui tam provision unconstitutional) is a highly distinct possibility. The judges seemed genuinely troubled by the lack of day-to-day executive oversight in declined whistle-blower lawsuits.  <br></p>



<p>However, regardless of whether the Eleventh Circuit upholds the law or strikes it down, <em>Zafirov</em> is on a fast track to the ultimate destination. Because a stark circuit split is opening up between courts upholding the False Claims Act and those questioning it, this case is highly likely to end up before the U.S. Supreme Court, where the future of American whistleblower law will be decided once and for all.</p>
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            <item>
                <title><![CDATA[Healthcare Enforcement Actions FAQ- Collateral Consequences]]></title>
                <link>https://www.conawayandstrickler.com/blog/healthcare-enforcement-actions-faq-collateral-consequences/</link>
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                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Fri, 22 May 2026 12:38:30 GMT</pubDate>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Health Care]]></category>
                
                    <category><![CDATA[Nursing License Defense]]></category>
                
                    <category><![CDATA[Physician License Defense]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                
                    <category><![CDATA[False. Claims Act]]></category>
                
                    <category><![CDATA[healthcare enforcement action]]></category>
                
                    <category><![CDATA[healthcare lawyer]]></category>
                
                    <category><![CDATA[Medicare Fraud]]></category>
                
                    <category><![CDATA[physician license defense]]></category>
                
                
                
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                <description><![CDATA[<p>Healthcare enforcement actions encompass criminal and civil charges, but, there are several important collateral consequences that need to be considered as well. What type of charges are considered Healthcare fraud? Providers who are alleged to have engaged in fraud and abuse are subject to sanctions under a number of Federal and State laws. Sanctions under&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Healthcare enforcement actions encompass criminal and civil charges, but, there are several important collateral consequences that need to be considered as well.  </p>



<p><strong>What type of charges are considered Healthcare fraud? </strong> </p>



<p>Providers who are alleged to have engaged in fraud and abuse are subject to sanctions under a number of Federal and State laws. Sanctions under Federal law, for example, can take the form of administrative, civil, and criminal penalties. These penalties range from monetary fines and damages to prison time and exclusion from the Federal health care programs, including Medicaid. Becoming familiar with common types of fraud, will better position providers to ensure they are not involved in such conduct. Providers will also be better equipped to identify and report others who may be engaged in fraud.   Allegations can include: Medical Identity Theft, Billing for Unnecessary Services or Items, Billing for Services or Items Not Furnished, Upcoding, Kickbacks, False Claims, among others.  A non exhaustive list of recent enforcement actions can be found <a href="https://oig.hhs.gov/fraud/enforcement/?type=criminal-and-civil-actions" id="https://oig.hhs.gov/fraud/enforcement/?type=criminal-and-civil-actions">here.</a>  </p>



<p><strong>What are common federal medicare fraud charges?</strong></p>



<p>Healthcare Fraud (18 USC §1347)<br>Aggravated Identity Theft (18 USC §1028(A)<br>Wire Fraud (18 USC §1343)<br>Money Laundering (18 USC §§1956 and 1957)<br>Conspiracy (18 USC §371)</p>



<p>Please see <a href="https://www.justice.gov/criminal/criminal-fraud/health-care-fraud-unit/2025-national-hcf-case-summaries" id="https://www.justice.gov/criminal/criminal-fraud/health-care-fraud-unit/2025-national-hcf-case-summaries">here </a>for some recent criminal actions.  <a href="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/medicaid-medicare-fraud/" id="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/medicaid-medicare-fraud/">Medicare fraud</a> prosecutions continue to be the focus of various task forces throughout the country.  </p>



<p><strong>What are the five most important Federal fraud and abuse laws that apply to physicians?</strong></p>



<ol class="wp-block-list">
<li>False Claims Act (FCA) 31 U.S.C. § § 3729-3733</li>



<li>The Anti-Kickback Statute (AKS) 42 U.S.C. § 1320a-7b(b)</li>



<li>The Physician Self-Referral Law (Stark law) 42 U.S.C. § 1395nn</li>



<li>The Exclusion Authorities 42 U.S.C. § 1320a-7</li>



<li>The Civil Monetary Penalties Law (CMPL) 42 U.S.C. § 1320a-7a</li>
</ol>



<p><strong>What is the NPDB</strong>?</p>



<p>The <a href="https://www.npdb.hrsa.gov/index.jsp" id="https://www.npdb.hrsa.gov/index.jsp">National Practitioner Data Bank</a> is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. Established by Congress in 1986, it is a workforce tool that prevents practitioners from moving state to state without disclosure or discovery of previous damaging performance.  If a  negative report about a physician<br>is made to the National Practitioner Databank, for example, the physician is greatly affected. </p>



<p>We work with the government to try and negotiate on the language and terms that will be reported to the National Practitioner Databank. We hope to provide as much clarity on the facts surrounding the matter that led to the suspension that is being reported.  </p>



<p><strong>What is the OIG LEIE?</strong></p>



<p>The OIG LEIE is the List of Excluded Individuals and Entities, a database maintained by the U.S. Department of Health and Human Services (HHS) Office of Inspector General. It lists healthcare professionals and organizations banned from participating in or billing federally funded healthcare programs like Medicare and Medicaid.  </p>



<p>OIG’s LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE.  The federal government gives a wonderful <a href="https://oig.hhs.gov/faqs/exclusions-faq/" id="https://oig.hhs.gov/faqs/exclusions-faq/">FAQ page</a> to answer basic questions about the exclusions list.  </p>



<p>Search the federal list <a href="https://exclusions.oig.hhs.gov/" id="https://exclusions.oig.hhs.gov/">here</a> and the state of Georgia <a href="https://dch.georgia.gov/office-inspector-general/georgia-oig-exclusions-list" id="https://dch.georgia.gov/office-inspector-general/georgia-oig-exclusions-list">here.</a></p>



<p>Conaway & Strickler, PC has experienced healthcare attorneys ready to help with any further questions. <a href="https://www.conawayandstrickler.com/contact-us/" id="https://www.conawayandstrickler.com/contact-us/">Contact us </a>at any time to get answers on your matter.  </p>



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