What the statute is
The False Claims Act makes it unlawful to knowingly present a false or fraudulent claim for payment to the United States, or to knowingly use a false record or statement material to such a claim.§ Source, statute, see sources page It also reaches a person who knowingly avoids an obligation to pay money to the government.§ Source, statute, see sources page
A defendant found liable is subject to treble damages and a civil penalty for each false claim.§ Source, statute, see sources page Penalty amounts are adjusted annually for inflation.
The Act is the government's primary civil tool for fraud on federal programs. In the fiscal year ending September 30, 2025, settlements and judgments under the Act exceeded $6.8 billion, the highest single-year total in its history. More than $5.7 billion involved health care.2 Source 2, see sources page The analysis explains why fraud on a system that size is hard to see.
What qui tam means
Qui tam is the provision that lets a private person file the case.§ Source, statute, see sources page The person who files is called the relator. The case is brought in the name of the United States, and the United States remains the real party in interest even when it does not take over the case.
Congress strengthened these provisions in 1986.2 Source 2, see sources page Since then they have carried a large share of the enforcement record. Through FY2025, total False Claims Act settlements and judgments were $85,652,583,093, of which $60,972,925,646 came from qui tam matters.3 Source 3, see sources page
In FY2025, whistleblowers filed 1,297 qui tam suits, the highest number in a single year, and the government opened 401 investigations.2 Source 2, see sources page
What a relator is
A relator is a private person who files a False Claims Act case on the government's behalf. Relators are usually people who saw the conduct from inside: employees, clinicians, billing and coding staff, compliance officers, contractors, analysts, and competitors.
A relator does not need to have been harmed personally, but does need original information. The statute bars a case that rests on allegations already publicly disclosed, unless the relator is an original source of the information.§ Source, statute, see sources page
Only one relator can bring a given case. While a first case based on the same underlying facts is pending, no other person may bring a related action.§ Source, statute, see sources page
What has to be proved
Four issues recur at the start.
- Falsity
- A claim, record, or statement that was false, or a certification of compliance that was not true.
- Knowledge
- The statute defines knowing conduct as actual knowledge, deliberate ignorance of the truth, or reckless disregard of the truth. It does not require a specific intent to defraud.§ Source, statute, see sources page
- Materiality
- The statute defines material as having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.§ Source, statute, see sources page Courts take that requirement seriously, and a technical violation that the government would have paid anyway is usually not enough.
- Government money
- The claim has to touch federal funds, directly or through a program that pays with them.
What protection exists
The False Claims Act includes anti-retaliation provisions.§ Source, statute, see sources page They address an employee, contractor, or agent who is discharged, demoted, suspended, threatened, harassed, or otherwise discriminated against in the terms of employment because of lawful acts taken in furtherance of a False Claims Act case. Relief can include reinstatement, back pay with interest, and compensation for special damages, in the amounts the statute sets.§ Source, statute, see sources page
The statute describes what a court can award after retaliation. It does not stop retaliation from happening. Anyone considering a case should plan for that difference.
Two further protections are procedural. The complaint is filed under seal and is not served on the defendant until the court orders it.§ Source, statute, see sources page The relator's identity is not public while the case is sealed.
What the process looks like
A qui tam case moves through the stages below in order. How long each stage takes varies from case to case.
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Assessment
We learn what you saw, what records exist, and what rule the conduct would have broken. Nothing is filed at this stage.
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Investigation
We test the account against the program rules, the claims data we can obtain, and the alternative explanations. Most patterns stop here.
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Filing under seal
The complaint is filed in camera and under seal. It is not served on the defendant. A written disclosure of substantially all material evidence and information the relator possesses is served on the United States.§ Source, statute, see sources page
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The seal period
The statute provides an initial period during which the case stays sealed while the government investigates. The government may ask the court to extend it for good cause, and often does.§ Source, statute, see sources page
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Litigation or resolution
Pleadings, discovery, experts, dispositive motions, and then trial or settlement. This stage is measured in years.
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The relator's share
If the case recovers money, the court determines the relator's share. The statute sets a range, and the outcome depends on the posture of the case and the relator's contribution.§ Source, statute, see sources page
In a successful qui tam case, the relator may receive a share of the government's recovery. The Department of Justice reports that share typically ranges between 15% and 30%.2 Source 2, see sources page The amount depends on statutory factors and the circumstances of each case, and no share is guaranteed. Prior results do not guarantee a similar outcome.
Time limits
A False Claims Act case has a deadline, and more than one limitations period can run at the same time. One period runs from the violation itself. A shorter one runs from the date the material facts were known or reasonably should have been known to the responsible United States official. An outer limit, measured from the violation, caps both.§ Source, statute, see sources page
The statute fixes those periods. Which one governs a particular case depends on facts a lawyer has to look at, which is a reason to ask early.
The first-to-file bar and the public disclosure bar can end a case that is otherwise sound.§ Source, statute, see sources page Both are reasons to move early and to keep the matter confidential.
What we need from you
Be accurate about what you personally know, and bring these, in whatever form you have them.
- What you saw, and how you saw it. Directly, or from someone who told you, or from a document.
- When it happened, as precisely as you can place it. A month and a year is useful, as long as you tell us when you are estimating.
- What program was billed. Medicare fee-for-service, Medicare Advantage, Part D, Medicaid, TRICARE, or something else.
- What rule you believe was broken, or simply what looked wrong. A coverage rule, a documentation requirement, a coding standard, a referral relationship, a delivery that did not happen.
- How large you think it is, and how you arrived at the number. If you heard the figure from someone else, say so.
- Who else knows. Including whether anyone has reported it internally, to a hotline, to a regulator, or to a law enforcement agency.
- What records exist and where they are kept. Describe them. Do not gather them before we have spoken.
Tell us what you are not sure about. The difference between what you know and what you assume matters to the case, and we would rather identify it early.
The method sets out what the firm does with an account after that, and what an account has to survive before anything is filed.
