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Fundamentals of the False Claims Act in Health Care


Identify the continuing and emergent issues facing providers under the False Claims Act and analyze ways these issues can be avoided or abated.

The False Claims Act remains the federal government's primary weapon in fighting fraud, as well as one that produces significant financial recoveries. Aided by qui tam relators, the government recovered $1.3 billion in 2023, and a substantial majority of the largest recoveries came from the health care space, including cases involving interlocking referral and financial relationships under the Anti-Kickback Statute and Stark Law, and billing and coding fraud in the Medicare and Medicaid programs. As the post-Covid era evolves, the number and magnitude of False Claims Act cases continue to increase and, again, health care is in the spotlight. Thus, we examine the lessons of the recent past and identify the continuing and emergent issues facing providers under the False Claims Act and analyze ways in which these issues can be avoided or abated.

We also examine how the federal courts are approaching False Claims Act claims and defenses, including splits among the Circuit Courts of Appeals on issues like materiality, standing, and implied certification as affected by advances in technology, cybersecurity and artificial intelligence.



Stuart M. Gerson

Stuart M. Gerson

Epstein Becker & Green, P.C.

  • Former Acting Attorney General of the United States, Assistant Attorney General, and federal prosecutor with hands-on enforcement and policy experience with respect to antitrust and data privacy and security
  • Experience in counseling and defending companies in antitrust litigation, including the successful court defenses of recent hospital mergers and other healthcare-related cases
  • Successful defense of class action litigation related to the privacy of both PII and PHI
  • Broad successful litigation and counseling experience with respect to the Federal False Claims Act and other fraud actions
  • As a corporate director, head of a compliance committee in a heavily data-centric industry
  • Director of National Council of Registered ISAOs, related to the adoption of best cyber practices and the fostering of public/private partnerships
Daniel Fundakowski

Daniel Fundakowski

Epstein Becker & Green, P.C.

  • Partner with Epstein Becker Green based in Washington, D.C. office
  • Practice focuses on representing health care clients in civil litigation and regulatory proceedings, including matters arising under the False Claims Act (FCA)
  • Has experience litigating and resolving FCA cases predicated on a wide variety of theories, including alleged violations of the Stark Law and the Anti-Kickback Statute, as well as cases involving allegations of upcoding, medical necessity, off-label promotion, research cost mischarging, and improper reporting of usual and customary prices
  • Also frequently designs and implements compliance programs, conducts internal investigations, and advises health care clients on day-to-day regulatory matters
  • Can be reached at (202) 861-1826 or [email protected]

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