Imagine you work at a medical care facility. You keep your head down, work hard, and truly value your job. You save lives, you are a real-life hero. It may not always feel that way, but at the end of the day, when you go home to your family, you know you did everything you could to help patients and keep families together. Day after day, you show up, dedicated to that mission. You don’t cut corners; you’re honest and trustworthy. Then one day, you notice something troubling. You see a billing and invoice sheet charging the government for treatments you never provided. At first, you think it must be an honest mistake. You alert the billing department, after all, if Medicare is being overcharged, it means your taxes are paying for those fraudulent treatments. The billing department assures you it’s a normal error that will be quickly fixed and everyone reimbursed. Relieved, you move on.

But then the same error happens again. This time, you hesitate to say anything, curious if it’s a recurring mistake. Unfortunately, it keeps happening, again and again, not just to you but to your coworkers as well. Slowly, you begin to realize something far worse is going on: major fraud. The hospital is intentionally overbilling Medicare, stealing from the American taxpayer, your friends, family, and neighbors. Confused and unsure of what to do, you ask an attorney what you can do. The attorney explains there is a legal framework to stop this kind of fraud, and that not only can you help end it, but you may also be entitled to a financial reward for blowing the whistle.

The attorney explains that there is a law allowing you to bring the claim directly to the government and have United States Attorneys prosecute the case. This law is called the False Claims Act (“FCA”). Under the FCA, if your claim leads to a recovery, you could earn up to 30% of the total amount recovered. In cases involving large-scale fraud, whistleblowers have received awards of over $100 million for exposing the wrongdoing.

A valid FCA claim must establish three elements: “(1) a false or fraudulent claim; (2) which was presented, or caused to be presented, by the defendant to the Government for payment or approval; (3) with the knowledge that the claim was false.” United States v. Marder, 208 F. Supp. 3d 1296, 1312 (S.D. Fla. 2016) (citing 31 U.S.C. § 3729(a)(1)(A)). The third element specifically requires “the provider knowingly asks the Government to pay amounts it does not owe.”

The first element is met “when a supplier submits a claim that misidentifies the goods supplied or requests reimbursement for goods that it never provided.” United States ex rel. Phalp v. Lincare Holdings, Inc., 116 F. Supp. 3d 1326, 1344 (S.D. Fla. 2015). The second element is satisfied when a claim is presented to the government. This violates the FCA when “ [the] conduct… caused the submission of a claim for Medicare reimbursement[.] [I]f the conduct was (1) a substantial factor in inducing providers to submit claims for reimbursement, and (2) if the submission of claims for reimbursement was reasonably foreseeable or anticipated as a natural consequence of defendants' conduct.” Marder, 208 F. Supp. 3d at 1312. The third element is established if the accused “person (1) has actual knowledge of the truth or falsity of the information, (2) acts in deliberate ignorance of the truth or falsity of the information, or (3) acts in reckless disregard.” Id.

FCA Lawsuits require a higher standard of evidence than most lawsuits. FCA lawsuits are governed by Rule 9 of the Federal Rules of Civil Procedure. “Federal Rule of Civil Procedure 9(b), which provides that a party alleging fraud ‘must state with particularity the circumstances constituting fraud or mistake.’” This means general allegations are not enough. An FCA complaint must spell out the fraud in detail—have attached my 2nd legal blog of the week to this email.

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what happened, who did it, when and where it occurred, and how it amounted to fraud.” Vargas v. Lincare, Inc., 134 F.4th 1150, 1157 (11th Cir. 2025). “[T]he most direct way to satisfy that requirement is by identifying specific claims submitted to the government: invoices, billing records, reimbursement forms.” Id. An FCA claim “must allege facts showing that a false claim was actually submitted to the government.” Id.

If you believe you have direct evidence that a false or fraudulent claim was submitted or caused to be submitted to the government for payment, and that those involved knew the claim was false, you may have a valid FCA claim. Such a claim could entitle you to a significant financial reward, while also helping protect the American taxpayer from waste and fraud.

If you believe you have uncovered a fraudulent claim, contact Joe Ingram or Joe Joe Ingram Law, LLC at 205-335-2640. Get Relief Get Result