An Overview of the False Claims Act
False Claims Overview
The General Accounting Office (GAO) estimates that medical fraud and abuse approaches 10% of all health care expenditures or $100 billion dollars.1 To reduce this thievery, the Justice Department and private litigators have used the False Claims Act (FCA) as the fraud fighting weapon of choice.2 Private litigators are given standing to file civil suit on the Federal government’s behalf by the FCA’s qui tam, or “whistleblower” provisions.3 Qui tam is short for qui tam pro domino rege quam pro se ipso in hac parte sequitur or "he who brings the action for the king as well as for himself [sic].”4
These provisions gained renewed public attention following the 1986 False Claims Act Amendments. The 1986 Amendments made it easier for qui tam relators to file claims and increased the rewards for doing so.5 Initially, the FCA was used to fight defense contractor fraud, but it was soon applied to other areas of government spending, including Medicare and Medicaid.
The qui tam provisions’ growing application to medical fraud reflects their effectiveness. In 1988, medical fraud recoveries, using the qui tam provisions, totaled a mere 1 percent of the total qui tam recoveries--the majority were defense related.6 By 1993, that total had grown to 46 percent and has remained over one third of total qui tam recoveries ever since.7
This paper examines the qui tam lawsuit from plaintiff and defendant perspectives. First, I briefly review the history and current scope of the False Claims Act. Second, I examine the elements of a qui tam action. Third, I suggest some strategies for those institutions and individuals who are actual or potential defendants in a qui tam action. In conclusion, I explore the reaction of the health care industry to this powerful law and possible future outcomes.
Qui tam’s origins
In the United States, laws dating back to 1790 authorized private citizens to sue on behalf of the Federal Government.8 However, the FCA statute being used today passed in March 1863 following Congressional reaction to fraud perpetrated by Union Army suppliers. The triggering incident occurred when a key Union position was jeopardized by the delivery of rifle and ammunition boxes containing only sawdust.9
Known as the Lincoln Law, defendants shown to have defrauded the government faced penalties of double the damages suffered by the government plus a $2,000 civil penalty per false claim.10 The qui tam relator received fifty per cent of the recovery.11
In 1943, Congress amended the FCA following a multitude of “parasitic” lawsuits in which plaintiffs sued based on information already in the government’s possession.12 The
Congressional changes barred use of information in the public record and lowered the reward to between 10 and 25 percent of any recovery.13 As a result, until Congress changed the law in 1986, few qui tam cases were filed.
During the 1980s defense buildup, reports of $400 dollar hammers and $800 dollar toilet seats led Congress to revise the statute.14 The 1986 FCA amendments raised the reward for qui tam plaintiffs to between 15 and 30 percent of the recovery, eased restrictions on the use of public information, and inserted provisions to allow the plaintiff to recover damages stemming from workplace retaliation.15 As a result, qui tam lawsuits dramatically increased.
The scope of the False Claims Act
The FCA is broadly applicable to almost any situation where federal dollars are involved. Given the Act’s current structure it seems that categories of qui tam cases will grow--limited only by the qui tam plaintiff’s tenacity and ingenuity. This possibility is reflected in the many categories of cases resulting in qui tam recoveries including, but not limited to, failures to report fraud16; education grants17; housing programs18; emergency relief programs19; fraudulent pre-selection of beneficiaries for Federal programs20; defense contracting21; agriculture support programs22; false certifications of compliance with environmental laws23; vehicle parts suppliers24; and, Medicare/Medicaid fraud.25
Since the focus of this paper is on medical fraud, I will explore that category in greater detail.
Medical fraud subcategories include:
1. double billing;
2. use of untrained personnel to provide services;
3. failure to supervise unlicensed personnel;
4. distribution of unapproved devices or drugs;
5. forgery of physician’s signatures;
6. creation of phony insurance companies or employee benefit plans;
10. services provided without medical necessity;
11. fraudulent cost reports;
12. inadequate care, and;
13. use of substandard equipment.
Federal health care enforcement initiatives
On March 21, 1995, FBI Director Louis Freeh stated that organized crime has “penetrated virtually every legitimate segment of the health care industry.”27 That is why Attorney General Janet Reno ranks health care fraud “one of the highest priorities” of the Justice Department.28 Congress responded to Reno and Freeh by passing the Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Act), found at § 1128C(a) of the Social Security Act.29
The Act requires that, after restitution, compensation, and relator’s awards are paid, all health care related criminal fines, forfeitures, and civil and administrative penalties and judgements be placed in the Federal Hospital Insurance Trust Fund.30 The Secretary of Health and Human Services (HHS) and the Attorney General can then appropriate money from the fund to combat fraud. In 1997, the program’s first year, the Attorney General
appropriated $104 million from this fund.31 Separately, the FBI received $47 million.32 Consequently, all 94 U.S. Attorney’s offices have coordinated criminal and civil enforcement teams and the FBI has 370 agents dedicated to health care fraud.33 The False Claims Act is the statute of choice for the U.S. Attorney’s engaged in this effort.34 In particular, qui tam cases represent about one third of total recoveries.35
The effort has produced dramatic results. In 1997, prosecutors filed 282 criminal indictments and “opened” 4,010 civil matters, a 61 percent increase over 1996.36 They won $1.2 billion and collected $1.087 billion in judgments, settlements, and administrative fines.37 Furthermore, over 2,700 individuals and entities were excluded from federal health care programs.38
However, the qui tam provisions’ greatest impact is in their deterrent effect. Professor William Stringer estimated that the deterrence value of qui tam lawsuits saved the Federal Government between $35.6 billion to $71.3 billion from 1986-1996.39 Over the next ten years, Professor
Stringer projects that the FCA’s qui tam provisions will save $105.1 billion to $210.1 billion.40
The False Claims Act and its qui tam provisions
The False Claims Act, 31 U.S.C. § 3729 et seq., establishes liability when any person or entity improperly receives from or avoids payment to the Federal government--tax fraud excepted.41 In summary, the Act prohibits:
1. Knowingly presenting, or causing to be presented to the Government a false claim for payment;
2. Knowingly making, using, or causing to be made or used, a false record or statement to get a false claim paid or approved by the government;
3. Conspiring to defraud the Government by getting a false claim allowed or paid;
4. Falsely certifying the type or amount of property to be used by the Government;
5. Certifying receipt of property on a document without completely knowing that the information is true;
6. Knowingly buying Government property from an unauthorized officer of the Government, and;
7. Knowingly making, using, or causing to be made or used a false record to avoid, or decrease an obligation to pay or transmit property to the Government.
The important 1986 changes were:
1. The elimination of the “government possession of information” bar against qui tam lawsuits;
2. The establishment of defendant liability for “deliberate ignorance” and “reckless disregard” of the truth;
3. Restoration of the “preponderance of the evidence” standard for all elements of the claim including damages;
4. Imposition of treble damages and civil fines of $5,000 to $10,000 per false claim;
5. Increased rewards for qui tam plaintiffs of between 15-30 percent of the funds recovered from the defendant;
6. Defendant payment of the successful plaintiff’s expenses and attorney’s fees, and;
7. Employment protection for whistleblowers including reinstatement with seniority status, special damages, and double back pay.
Initiating a Civil Action for False Claims
The Attorney General initiates most civil actions for false claims.42 When private individuals file an action under the FCA it is brought in the government’s name.43 The claim is filed in camera and under seal in the U.S. District Court with jurisdiction over the claim.44 Copies of the complaint and a written disclosure of all material evidence and information should be served on the local U.S. Attorney and in Washington, D.C. with the U.S. Attorney General.45
Government Intervention and Involvement
The government has chosen to intervene in 22 percent of the cases it has reviewed.46 The Government has 60 days from the time the sealed complaint is filed to decide whether or not to intervene.47 However, the Government may obtain an extension for “good cause shown.”48 In almost all cases the government will ask for an additional 60 days to investigate the complaint.49 In that 120 day period, Justice Department, FBI, Office of Inspector General (OIG), and HHS resources may be employed to interview the relator and her counsel, review the relator’s complaint and supporting documents, wiretap, inspect the medical provider’s documents at their place of business, and review the medical provider’s filings with Medicare and Medicaid.50 If the case is strong and the
potential recovery is high enough, the government will probably intervene.51
Government intervention is generally good for the relator. The prospective defendant is apt to be intimidated by the government’s massive effort. However, when the Government intervenes, the relator, though still a party to the action, loses control of the proceedings and the relator’s reward is limited to between 15 and 25 percent of the government’s total recovery52 plus reasonable attorney’s fees and expenses.53 One AUSA made clear the effect of government intervention when he stated “if we intervene, [the relator and her counsel] will not be active participants. When we take the case over, we do take it over.”54 This leaves the government free to negotiate with the defendant as long as the resulting settlement is “fair, adequate, and reasonable.”55
Even when the government initially declines to intervene, it retains intervention rights throughout the subsequent proceedings.56 Furthermore, when a relator settles a case 31 U.S.C. § 3730(b)(1) provides that “the action may be dismissed only if the court and the Attorney General give written consent to the dismissal and their reasons for consenting.” Despite this wording, some courts have held that if the government declines to intervene, either while the case is under seal or during the course of the action, then it loses standing to object to voluntary dismissal of the action57 or to object to the settlement
terms between the defendant and the relator.58 Finally, when the government declines to intervene the relator’s share of the award increases to between 25 and 30 percent of the recovery plus reasonable attorney’s fees and expenses.59
Jurisdiction and Venue
A qui tam action may be brought in any judicial district in which the defendant(s) can be found, resides, transacts business, or in which the false claim occurred.60 Under § 3732(a), the Federal Courts may also have jurisdiction over state whistleblower claims if they arose from the same transaction or occurrence that triggered the Federal qui tam action.61 This is important in states such as Ohio, Florida, and California that have their own whistleblower statutes.62
The Statute of Limitations
The Statute of Limitations is defined under § 3731(b). A claim must be brought within six years from the date on which the violations of § 3729 were committed or three years after the date when facts material to the right of action are known or reasonably should have been known by the United States official charged with the responsibility to act in the circumstances, but not more than 10 years after the date of the violation, whichever occurs last. A relator is not required to file suit as soon as he or she uncovers the
false claims. However, the reward may be reduced by the Court if the relator unreasonably delays bringing the action.63
Under 31 U.S.C. § 3730(a), the U.S. Attorney General is empowered to institute a civil action against persons that submit claims in violation of 31 U.S.C. § 3729. Section 3730(b) contains the qui tam provision which provides for “a person” to bring a civil action on the government’s behalf for violations of § 3729.
To have standing under Article III of the Constitution the relator must show actual or threatened injury.64 In several cases, defendants have unsuccessfully attempted to challenge the relator’s standing.65 United States ex rel. Truong v. Northrop Corp was the clearest opinion rejecting such challenges.66 In that case, the court found that the relator’s standing stemmed from the injury to the Federal Government in whose name the suit was brought.67 The relator’s standing is not an issue when the U.S. government intervenes or when the relator has suffered actual damages due to actions taken by his or her employer.
The Relator and Subject Matter Jurisdiction
Unless the relator bringing the qui tam lawsuit is the “original source” of the information, the court will lack
subject matter jurisdiction.68 To be an original source the relator must have “direct and independent knowledge of the information on which the allegations are based.”69 Furthermore, the relator must have “voluntarily provided the information to the Government before filing the action....”70
The Federal Appeals Courts are divided on their interpretations of “public disclosure,” and “original source.” For example, the D.C. Circuit Court of Appeals held that a qui tam claim is barred only if it is based on publicly disclosed “allegations or transactions” but not if it is based on mere “information” that does not clearly expose the fraud.71 The First Circuit Court of Appeals has been the most liberal in its interpretation of original source. It simply held that a qui tam claim “that has not yet been the subject of a claim by the government... will be allowed to go forward.”72 However, the Second Circuit Court of Appeals is more restrictive. It held that “public disclosure of the allegations divests district courts of jurisdiction over qui tam suits.”73
The Sixth Circuit seems to follow a middle course. In U.S., ex rel. Pogue v. American Healthcorp., Inc., the court held that “Congress sought to prohibit qui tam actions only when either the allegation of fraud or the critical elements of the fraudulent transactions themselves were in the public domain.”74 In that case, the court found that business prospectuses, one annual report, and three independent newspaper reports contained “language too general to put the
reader on the trail of the alleged illegal referral scheme.”75 The court cited the D.C. Circuit Court’s opinion in U.S. ex rel. Findley v. FPC-Boron Employees’ Club which held that a relator’s claim will not be invalidated unless the public disclosures “specifically identify the nature of the fraud.”76
The scienter or knowledge requirement under the FCA is less than the elements of common law fraud.77 As noted above, the plaintiff must prove either 1) actual knowledge of the falsity of the information submitted to the government; 2) deliberate ignorance of the truth or falsity of the information; or 3) a reckless disregard of the truth or falsity of the information.78 Thus, only the defendant’s negligence or innocent mistake will go unpunished.
There are some differences among the Circuit Courts regarding Federal Rule of Civil Procedure 9(b)’s requirement that fraud be pleaded with particularity. Rule 9(b) requires that “in all averments of fraud or mistake, the circumstances constituting fraud or mistake shall be stated with particularity. Malice, intent, knowledge, and other condition of mind of a person may be averred generally.” The Sixth Circuit has construed Rule 9(b), as requiring a plaintiff to allege, at minimum, “the time, place, and
content” of the alleged misrepresentation constituting fraud.79 However, in the Sixth Circuit, Rule 9(b) is modified by Rule 8 which calls for simple, concise and direct allegations in pleading.80 For example, in Pogue the court held that, even though the plaintiff gave no specific dates nor identified any particular employees, his general reference to a time frame of 12 years and his identification of the corporation’s involved met the particularity requirement.81 Furthermore, an Illinois District Court, in U.S. ex rel. Robinson v. Northrop Corp., held that “pleadings cannot generally be based on information and belief unless the factual information is ‘peculiarly within the defendant’s knowledge or control.’”82 Thus, there are alternative means to satisfy Rule 9(b) requirements as long as the defendant is provided with “fair notice of the claims against him.”83 Despite these possibilities, plaintiffs should do their best to meet the time, place, and content requirements to avoid defendant motions to dismiss and to better sell their cases to the U.S. Attorneys reviewing the complaints.84
Double jeopardy considerations
Under § 3731(d), the civil case is stayed during the defendant’s criminal trial. Once the defendant is either convicted, pleads nolo contendere, or pleads guilty, the defendent is estopped “from denying the essential elements of the offense in any action which involves the same
transaction as the ciminal proceeding.” Thus, the civil trial is carried out only to determine damages.85 As can be seen in the above listing of damages and penalties, the qui tam penalties can be great.
In December 1997, the Supreme Court, in Hudson v. U.S., overturned U.S. v. Halper and held that civil penalties plus criminal fines do not violate the Constitution’s double jeopardy clause.86 In Halper, the defendant overcharged Medicare by $9.00 on each of 65 claims he submitted--$585.00 total.87 He was subsequently convicted of violating 18 U.S.C. § 287, the criminal false claims statute and sentenced to two years in jail and fined $5,000.88 The government then sued him under the FCA attempting to hold him liable for a further $130,000.89 In that case, the Supreme Court affirmed a federal district court decision which held that the FCA penalty violated the double jeopardy clause given Halper’s criminal conviction.90
In rejecting Hudson, Chief Justice Rehnquist, writing for the majority, stated that “we believe that Halper’s deviation from longstanding double jeopardy principles was ill considered.”91 The Supreme Court held that the Fifth Amendment’s double jeopardy clause “protects only against the imposition of multiple criminal punishments for the same offense ... and then only when such occurs in successive proceedings.”92 The court stated that “the ills at which Halper was directed are addressed by other constitutional provisions. The Due Process and Equal Protection Clauses
already protect individuals from sanctions which are downright irrational.”93
Settling a qui tam/FCA lawsuit
The settlement agreement in U.S. ex rel. Wagner v. Allied Clinical Laboratories provides an example of a fairly typical settlement agreement. In that case Allied falsely submitted claims to Medicare to induce improper payment for tests and improperly collected Medicare payments.
In summary the agreement provided that:
1. Allied would repay to the United States $4,900,000 of which $833,458 was paid directly to the relators;94
2. That Allied was released from any civil or administrative monetary claims under the FCA, the Program Fraud Civil Remedies Act, 31 U.S.C. § 3801 et seq.; the Civil Monetary Penalties Law, 42 U.S.C. § 1320a-7a; or the common law for the conduct described in the Civil Action;95
3. That Allied was released from civil or administrative monetary penalties under the above categories from liability for all acts Allied voluntarily disclosed following an internal audit of all its billing practices;96
4. The United States does not release Allied or any other entity or individual from any criminal liability arising from the conduct described in the Civil Action.97
5. That Allied will take “all reasonable and necessary steps” not to resubmit any false claims;98
6. That Allied will abide by a Corporate Integrity Agreement for five years;99
In that case, the Corporate Integrity Agreement required that Allied implement a Corporate Integrity Program (CIP) covering all company directors, officers, employees, and independent contractors associated with Allied’s sales, performance, or billings for lab services.100 In brief,
this program consisted of:
1. The formation of a CIP Management Committee consisting of the regional general managers of the corporation;101
2. The designation of a Corporate Compliance Officer;102
3. The submission by the Committee of quarterly reports to the Board of Directors with copies sent to HHS;103
4. The development of written “Standards of Conduct” to be distributed to “all persons covered by the CIP.”104
5. A requirement to develop an ongoing training and education program for all present and future employees to ensure future compliance with the law;105
6. Removal of all employees involved in the matters described in the Civil Action.106
7. A requirement to make “reasonable inquiries” to determine whether or not any present and future employees, agents, or contractors has ever been convicted of a criminal offense related to health care or is otherwise ineligible to participate in federal programs and, if so, to terminate the relationship;107
8. Instituting an “annual review of its billing policies, procedures and practices” to ensure appropriate billing;108
9. Taking immediate corrective action when future violations occur including restitution and reporting to HHS;
10. Annual reporting to HHS of, among other things:
a. all actions taken to comply with the Agreement
b. a list of all documents dealing with compliance
c. verification of compliance training
d. a summary of all internal investigations and,
e. certification of compliance with the Agreement;109
11. Prior notification of HHS whenever the corporation acquires or sells or changes the name of any entities;110 and
12. Maintenance of all records for a period of six years.111
The settlement agreement also required that, upon reasonable notice, HHS have access to records and employees without a corporate representative present.112 Were Allied
to breech the agreement it could face exclusion or suspension from federal programs.113
Defendant’s negotiating a settlement agreement should also be aware that government attorney’s have often insisted on waiver of the attorney-client privilege and waiver of the work-product doctrine.114 Nevertheless, some settlements have not included such waivers.115 Furthermore, the government usually tries to limit releases to the behavior described in the complaint.116 Therefore, a defendant should attempt to negotiate a release of 1) all claims related to the subject matter, 2) a release for individuals for the same monetary damages and penalties for which the organization has already paid once, and 3) a catch-all release for claims under any statutory or regulatory provisions of the federal programs that could potentially cover the subject matter of the complaint.117
Preventing FCA lawsuits
Medical providers need to be aware that “all employees, sub-contractors, agents, representatives, shareholders, vendors, competitors, clients and the like are potential relators.”118 Furthermore, the harsh provisions of settlement agreements and other costs involved in defending an FCA lawsuit call for corporate medical providers to take preventive action simply to meet their fiduciary duty to stockholders.119
To reduce their exposure to qui tam lawsuits, medical providers should develop internal mechanisms to insure compliance with complex and constantly changing Medicare and Medicaid regulations. The benefits of an internal fraud detection program include early detection of problems, subversion of employees’ ability and inclination to bring a qui tam lawsuit, and the opportunity to voluntarily disclose fraud or mistakes thereby reducing penalties to double damages and also reducing fines.120
There is annual pressure on Congress to revise the False Claims Act. The American Hospital Association (AHA) has made weakening the False Claims Act its top priority.121 In particular, the AHA seeks to raise the intent level required to prove a false claim122 and to raise the burden of proof from a preponderance of the evidence standard to a clear and convincing standard.123
Ultimately, if medical providers have their way with Congress, the power of the FCA and its qui tam provisions may be fleeting. The AMA and the AHA are jointly spending millions on Capitol Hill lobbying efforts and in court battles to diminish the FCA’s power. Their efforts may stifle a dawning awareness of the FCA’s utility in fraud fighting efforts in many other sectors of our society.
However, if the FCA remains in its current form, an inventive citizenry will begin to more broadly use this
powerful tool to hold public officials, corporations, and individuals entrusted with the expenditure of trillions of taxpayer dollars to their word.
1Lawrence Thompson, Health Insurance: Vulnerable Payers Lose Billions to Fraud and Abuse, Report to the Chairman, Subcommittee on Human Resources and Intergovernmental Operations, U.S. House of Representatives, Washington, D.C. May, 1992. 231 U.S.C. §§ 3729-33 (1996). 3William Stringer, The 1986 False Claims Act Amendments: An Assessment of Economic Impact, September 1996, A Study Commissioned by Taxpayers Against Fraud, at 1. 4Black’s Law Dictionary, 1990. 5Sean Hamer, Lincoln’s Law: Constitutional and Policy Issues Posed by the Qui Tam Provisions of the
False Claims Act, 6-WTR Kan. J.L. & Pub. Pol’y 89. 6Paul Reidinger, Fraud Doctors: How a Law that Shot Down Defense Scams is Now Zeroing in on Bogus Health-care Costs, ABA Journal, May 1996, at 52.. 7Id. 8Anna Mae Walsh Burke, Qui Tam: Blowing the Whistle for Uncle Sam, 21 Nova L. Rev. 869, at 871. 9808 F.Supp. 580. 10See note 8, at 872. 11The 1986 False Claims Act Amendments: Tenth Anniversary Report, Taxpayers Against Fraud, at 5. 12The case that spurred the changes is the Supreme Court’s decision in Marcus ex rel. v. Hess, 317 U.S. 537 (1943), in which the Relator relying solely on information already in the government’s possession was successful in collecting his share of the damages. 13See note 11, at 6. 14Sanford Teplitzky and Harry Silver, False Claims Act Does Not Encompass Kickbacks or Violations of Stark, BNA Health Care Fraud Report, 5-7-97, at. 303. 1531 U.S.C. §§ 3729-33 (1996). 16Id § 3729(7). This is the so-called reverse false claim provision. In the medical context, where a corporation has discovered fraud through an internal compliance program, it is then required to repay Medicare or Medicaid. Were it to fail to do so, it may be held liable. See e.g. 885 F.Supp. 1055. 17Franklin Hoke, Novel Application of Federal Law to Scientific Fraud Worries Universities and Reinvigorates Whistleblowers: With Major Penalties the False Claims Act is Being Used to Hold Schools Accountable for Faculty Member’s Misconduct, The Scientist, 9, 17, Sept. 4, 1995. 18U.S. v. Incorporated Village of Island Park 791 F.Supp. 354 (E.D.N.Y. 1992) 19Lisa Hovelson, Speak Out: Support Your Local Whistleblower, GW Magazine, May 1995 at 33 20U.S. v. Incorporated Village of Island Fark, 888 F.Supp 419 (E.D.N.Y. 1995). 21Wang v. FMC Corp., 975 F.2d 1412 (9th Cir. 1992). 22United States ex rel. Sequia Oragnge Co. v. Sunland Packing House Co., 912 F.Supp. 1325 (E.D. Cal. 1995) 23See U.S. ex rel. Fallon v. Accudyne Corp., 888 F.Supp 636. 24Whistle Blower’s Website, visited 3-1-98. (www.whistleblowers.com) 25Medicare Fraud and the Lincoln Law, Advance, November 1994 at 29. 26Id. also see note 24 and Michael Mustokoff et al. The Government’s Use of the Civil False Claims Act to Enforce Standards of Quality of Care: Ingenuity or the Heavy Hand of the 800-Pound Gorilla, 6 Annals Health Law 137. 27Fraud and Abuse: Organized Crime has Penetrated Health Industry, FBI Director Says, 3 HCP 13 d7. 28Fraud and Abuse: Health Care Fraud is High Priority for Justice Department, Reno Claims, 4 HCP 25d8. 29Annual Report of the Departments of Health and Human Services and Justice: Health Care Fraud and Abuse Control Program 1997 at 1. 30Id at 3.
31Id at 4. 32Id. 33Id at 29. 34Id at 23. 35 See note 3 at 24 36See note 29 at 1. 37Id. 38Id at 2. 39Id at 40. 40Id. 41See note 11 at 10. 4231 U.S.C. § 3730(a) 4331 U.S.C. § 3730(b)(1) 4431 U.S.C. § 3730(b)(2) 45Telephone interview with Jim Bickett, Assistant U.S. Attorney for the Northern District of Ohio, Thursday, February 27, 1998. 46Georgia’s Biggest Whistleblower Case: Federal Suits Under ‘86 Multiply, Shift to Health Care Abuses, Daily Report, American Lawyer Media, 108, 26 Febraury 7, 1997 at 1. 4731 U.S.C. § 3730(b)(2) 4831 U.S.C. § 3730(b)(3) 49Interview with Assistant U.S. Attorney Alex Rokakis March 18, 1998. 50Id.. 51Id. In Ohio, “high enough” seems to be at least $100,000 in fraudulent claims made with a potential $500,000 recovery. 5231 U.S.C. § 3730(d)(1). 5331 U.S.C. § 3730(d)(4). 54See note 49. 5531 U.S.C. § 3730(c)(2)(B). 5631 U.S.C. § 3730(b)(5). 57U.S. ex rel. Pedicone v. Mazak Corp., 807 F.Supp 1350. 58U.S. ex rel. Stinson v. Provident Life and Accident Insurance Co., 811 F. Supp 346 (E.D. Tenn. 1992). 5931 U.S.C. § 3730(d)(2) and (4). 6031 U.S.C. § 3732(a). 6131 U.S.C. § 3732(b). 62See e.g. O.R.C. § 4113.52. 63United States v. General Electric, 808 F.Supp. 580 (S.D. Ohio 1992). 64Gladstone, Realtors v. Village of Bellwood, 441 U.S. 91, 99-100 (1979). 65United States ex rel. Stillwell v. Hughes Helicopters, Inc. 714 F.Supp. 1084 (C.D. Cal. 1989). 66728 F.Supp 615 (C.D. Cal. 1989). 67Id. 6831 U.S.C. § 3730(e)(4)(B) 69Id. 70Id. 71United States ex rel. Springfield Terminal Ry. Co. v. Quinn, 14 F.3d 345 (1994). 72United States ex rel. Doe v. John Doe corp., 960 F.2d 318 (1992). 73U.S. ex rel. Doe v. John Doe Corp., 960 F.2d 318 (1992) 74977 F.Supp. 1329, 1337. 75Id at 1339. 76Id. 77See note 21 at 1420. 78U.S.C. § 3729 (b). 79Coffey v. Foamex L.P., 2 F.3d 157, 161-162 (6th Cir. 1993). 80Michaels Building Co. v. Ameritrust Co., N.A., 848 F.2d 674, 679 (6th Cir.1988).
81Pogue v. American Healthcorp., Inc., 977 F.Supp. 1329, 1333 (M.D. Tenn. 1997). 82149 F.R.D. 142 at 145 (N.D. Ill. 1993) 83See note 80 at 679. 84See note 49. 8531 U.S.C. § 3731(d). 86Hudson v. United States, 118 S. Ct. 488 (1987). 87490 U.S. 435 (1989). 88Id. 89Id. 90Id at 450-451 91See note 86 at 494 92Id at 488 93Id at 496 94United States ex rel. Wagner v. Allied Clinical Laboratories, 1995 WL 254405 (S.D.Ohio), at 8. 95Id at 9. 96Id. 97Id. 98Id at 11. 99Id at 8. 100Id at 12. 101Id. 102Id. 103Id at 13. 104Id. 105Id. 106Id at 14. 107Id. 108Id. 109Id at 15. 110Id at 17. 111Id. 112Id at 18. 113Id. 114Francis Serbaroli, False Claims Act Settlement Negotiations, N97WCCB ABA-LGLED H-1 at 2. 115Id at 3. 116Id. 117Id at 3 118David Bradford, Qui Tam Litigation: An In House Perspective, N97WCCB ABA-LGLED I-19, at 3. 119In Re Carmark International Inc. Derivative Litigation, Del, Ct of Chancery 1996, 1996 WL 549894. 120Adam Snyder, The Fa1se Claims Act Applied to health Care Institutions: Gearing up for Corporate Compliance, 1 DePaul J. Health Care L. 1 at 40. 121Fraud and Abuse: AHA Calls False Claims Act, BBA Transfer Provisions Unfair, 6 HCP 262. 122See note 6 at 54. 123Fraud and Abuse: Reno Willing to Work with Hospitals to Ensure Proper Use of False Claims Act, 6 HCP 261.