“The False Claims Act imposes treble damages and penalties on those who knowingly and falsely claim money from the United States or knowingly fail to pay money owed to the United States. The False Claims Act thus safeguards government programs and operations that provide access to medical care, support our military and first responders, protect American businesses and workers, help build and repair infrastructure, offer disaster and other emergency relief, and provide many other critical services and benefits.”  Settlements and judgments under the False Claims Act exceeded $6.8 billion in the fiscal year ending Sept. 30, 2025, Deputy Attorney General Todd Blanche and Assistant Attorney General Brett A. Shumate, head of the Justice Department’s Civil Division announced in mid January of 2026. Healthcare fraud dominated recoveries, with approximately $5.7 billion of the total $6.8 billion tied to healthcare-related matters that included managed care, prescription drugs, and medically unnecessary services.

In addition, relators also set a new record with 1,297 new qui tam suits filed, breaking FY 2024’s record of 980 qui tam suits and nearly doubling the average number of new qui tam suits during FY 2010 to FY 2023.

it is important for clients to make sure your compliance programs are designed to mitigateFCA risk. Please contact us, we are here to help whether it is the beginning of an investigation, on the eve of trial, at the appellate stage or during settlement discussions.

“As alleged, these defendants exploited the COVID-19 pandemic to develop and carry out a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose,” said Attorney General Merrick B. Garland. These arrests mark the DOJ’s 1st criminal drug distribution prosecutions related to prescribing via telemedicine, the agency said.

Conaway & Strickler represent healthcare providers in fighting against allegations such as these by agencies such as the DOJ, HHS-OIG, FBI, Georgia Medicaid Fraud Control Units and cases nationwide. We have litigated federal healthcare cases in NJ, NY, LA, FL, TX and GA. We also represent healthcare providers in medical and professional licensing board matters as well.

Remember, physicians have to report issues to their professional liability carrier, insurers, etc. AND to the Georgia Composite Board. Thus, it is important to contact us immediately when an agent comes knocking asking “for just a few files” or “just a few questions”. Do not go it alone.

Qui tam is short for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which roughly translates to “he who brings an action for the king as well as for himself.” How does the Qui Tam definition relate to litigation today?

Today the federal False Claims Act (“FCA”) is the federal statute originally enacted in 1863. Many cases are filed under 31 §§ 3729 – 3733 by the government. But the FCA also allows private citizens to file suits on behalf of the government. These are called Qui Tam law suits. The private party is called a “relator” and they are the ones who bring an action on the government’s behalf. The government, not the relator, however, is considered the real plaintiff. Note if successful, a relator in a FCA Qui Tam action can receive up to 30% of the government’s award. The False Claims Act authorizes Qui Tam actions against parties who have defrauded the federal government. Qui Tam law suits are also called “whistleblower” law suits. How does it apply in the Health Care Field?

All Qui Tam actions involve actions against parties who have defrauded the federal government. Therefore, any current or former employee, consultant, independent contractor etc working in the medical field who has knowledge of schemes to defraud Medicare or Medicaid may be able to file a Qui Tam lawsuit. What types of schemes to defraud the federal government in the Health Care field are common?

Although not an exhaustive list, below are some common schemes to defraud:

-upcoding

-billing for dead patients

-billing for ineligible patients

-billing for services not provided

-unbundling

-kickbacks

-providing services that were not reasonable or medically necessary and/or failed to provide adequate and appropriate services to its patients.

Please see https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal-year-2020 for details on FCA claims for the year 2020.

Should you have additional questions or concerns about a potential whistleblower case for SEC, Health Care, Procurement, Education/Grant or Tax Fraud, please feel free to reach out to Conaway & Strickler, PC for more information. 404-816-5000 or info@cs-lawyers.com