False Claims Act Defense for Healthcare Providers
A False Claims Act case comes down to what your practice knew when the claim went out, since a claim that later proved wrong is not automatically a false one. Chapman, Dowling & Mallek rebuilds that knowledge record first, and our False Claims Act defense work for Detroit hospitals and providers nationwide shows where strong hospital False Claims Act defense actually lives: inside the documentation.
What Must the Government Prove in a False Claims Act Case?
Federal civil attorneys work from a short list of elements, and weakness in any one can end a case before trial. A defense review tests each against the chart notes and claim data:
- A claim submitted to Medicare, Medicaid, or TRICARE
- Falsity measured against the rule in force on the date of service
- Knowledge of that falsity, which includes reckless disregard
- Materiality to the government’s decision to pay
Materiality carries more weight than most administrators expect. A technical requirement the government paid on for years is hard to call material after the fact.
Billing Relationships that Pull Hospitals into Federal Review
Referral arrangements draw the closest look. Under 42 U.S.C. § 1320a-7b(g), a claim that includes any service resulting from an Anti-Kickback Statute violation counts as a false claim by itself. Medical director agreements, equipment leases, and call coverage stipends get priced against fair market value, while Stark Law self-referral rules add a layer requiring no proof of intent.
How Does a False Claims Act Defense Proceed?
Hospitals that bring in our False Claims Act defense attorney during the audit stage, rather than after a complaint unseals, keep more options open. A defense that starts at the civil investigative demand stage follows a set order:
- Preserve first: lock down claims data, chart notes, and email before collection.
- Rebuild intent: date every piece of coding guidance the billing staff used.
- Sample independently: run a coding audit that rejects the government’s extrapolation.
- Answer in writing: respond to the demand with facts and a documented timeline.
Independent sampling changes the number more than an argument does. Extrapolation from a small claim sample can turn a five-figure question into an eight-figure demand, and a defensible re-sample shrinks it the fastest.
Compliance Records that Hold Up in the Eastern District of Michigan
Health care fraud matters filed in Detroit run through the U.S. District Court for the Eastern District of Michigan, home to a Health Care Fraud Strike Force since 2009. Providers who keep dated written records of the coding advice they relied on hand a defense team something the government struggles to rebut, because subjective belief at the time of billing is the standard courts now apply.
Decide Now How Your Practice Answers the Government
Chapman, Dowling & Mallek has saved clients $550 million in fines, forfeitures, and restitution, much of it where providers moved before any indictment existed. Prior results do not guarantee a similar outcome. Call or text our 24-hour hotline at (346) 242-7626, or get in touch online with our team today to speak directly with a federal attorney.