Thank you for sharing!

Your article was successfully shared with the contacts you provided.

The False Claims Act is not just for fraud anymore. The 2009 amendments to the FCA drastically changed the way liability can be imposed under the reverse false claim provision of the Act. The expected increase in FCA cases and the expanded risk of treble damages and penalties places a heavy burden on any entity doing business with, or receiving funds from, the United States government to identify, quantify, and return overpayments. In 2009, Congress enacted the Fraud Enforcement and Recovery Act (FERA) containing amendments to the FCA and vastly expanding its reach. Among other things, FERA expanded the so-called “reverse false claim” provision of the FCA. The reverse false claim provision imposes liability under the FCA where one acts improperly not to get money from the government, but to avoid an obligation to pay money to the government. The 2009 amendments specified that an entity violates the FCA if it “knowingly and improperly avoids or decreases an obligation” to pay money to the United States—including an obligation based on an “established duty . . . arising from . . . the retention of any overpayment.” Though the 2009 amendments do not define any new obligations to return overpayments, the knowing and improper retention of an overpayment now forms the basis of reverse false claim liability, subject to treble damages and penalties. In 2010, Congress enacted the Patient Protection and Affordable Care Act (PPACA). The PPACA, also commonly referred to as “Obamacare,” clarified that for purposes of payments made under the Medicare and Medicaid programs, an overpayment must be reported and returned to the government within “60 days after the date on which the overpayment was identified,” or “the date any corresponding cost report is due,” whichever is later. While the word “identified” is not defined by the statute, and is likely to be the subject of considerable litigation in the future, the provision explicitly states that if the overpayment is retained beyond the 60-day period, it becomes an “obligation” sufficient for reverse false claim liability under the FCA, assuming that retention is “knowing and improper.” Adding further ambiguity to the amendments, the term “improper” is also left undefined. It is highly likely, however, that the government, whistleblowers, and perhaps even courts will interpret the “improper” retention of an overpayment as nothing more than knowing about an overpayment and failing to return it. As a result of these recent amendments, the FCA’s reverse false claim provision no longer requires evidence of a false statement or deceptive conduct on the part of the government contractor or recipient of federal funds. Under the prior versions of the FCA, in order for reverse false claim liability to attach, a defendant had to knowingly submit a “false record or statement” to the government, concealing its obligation to return funds. That requirement is gone. No longer must a defendant submit a false record or statement to conceal an obligation to return funds. Instead, the government (or private whistleblower) need only demonstrate that the defendant’s failure to return funds was “knowing and improper.” Accordingly, the FCA’s reverse false claim provision has been fundamentally altered to impose liability, treble damages and penalties in the absence of any fraud or false statement on the part of the entity receiving government funds. It is important to note that the risk of overpayments is not limited to situations where the government issues a payment in error. Overpayments can result from circumstances that may be difficult to predict. Many government reimbursement policies and regulations are highly complex, ambiguous, and difficult to interpret. Differing and evolving interpretations of these regulatory schemes could lead to “overpayment” claims by the government or whistleblowers. In addition, the reduction in the scope of a government contract, or a change in a government grant or loan program, could also result in a claim that an entity receiving government funds has retained an “overpayment.” Given the passage of time since these amendments were passed—and the FCA’s unique seal provisions that keep whistleblower complaints confidential while the government conducts its investigation—it is likely that cases alleging violations of the amended reverse false claim provision will be filed and/or unsealed in the near future. As a result, entities receiving government funds face increased scrutiny from both the government and whistleblowers seeking a bounty for bringing potential FCA violations to the government’s attention. General counsel of entities doing business with the government should make sure that safeguards and compliance initiatives are in place to track and return overpayments to the appropriate payor source in a timely fashion. General counsel should also have a mechanism in place to document in real time that the entity’s retention of overpayments while quantifying and processing them for refund does not reflect any intent to improperly retain the funds. In addition, all entities receiving government funds pursuant to government contracts are now exposed to FCA liability if they are overpaid under their contracts and fail to return the overpayments. When negotiating contracts with the government, general counsel of government contractors should take affirmative steps to clearly and explicitly define in the contracts the circumstances in which an overpayment would (or would not) arise, and when and how refunds are to be made. Those terms can include:

This content has been archived. It is available exclusively through our partner LexisNexis®.

To view this content, please continue to Lexis Advance®.

Not a Lexis Advance® Subscriber? Subscribe Now

Why am I seeing this?

LexisNexis® is now the exclusive third party online distributor of the broad collection of current and archived versions of ALM's legal news publications. LexisNexis® customers will be able to access and use ALM's content by subscribing to the LexisNexis® services via Lexis Advance®. This includes content from the National Law Journal®, The American Lawyer®, Law Technology News®, The New York Law Journal® and Corporate Counsel®, as well as ALM's other newspapers, directories, legal treatises, published and unpublished court opinions, and other sources of legal information.

ALM's content plays a significant role in your work and research, and now through this alliance LexisNexis® will bring you access to an even more comprehensive collection of legal content.

For questions call 1-877-256-2472 or contact us at customercare@alm.com


ALM Legal Publication Newsletters

Sign Up Today and Never Miss Another Story.

As part of your digital membership, you can sign up for an unlimited number of a wide range of complimentary newsletters. Visit your My Account page to make your selections. Get the timely legal news and critical analysis you cannot afford to miss. Tailored just for you. In your inbox. Every day.

Copyright © 2020 ALM Media Properties, LLC. All Rights Reserved.