Allegations of a violation of the False Claims Act (FCA) are serious. Physicians must make sure their billing practices are in line with this and other federal regulations or they can face steep financial penalties and potential imprisonment. Any physician who learns of allegations of a violation will likely have a lot of questions. One of which is likely how long the process will take.
In a recent example, the federal government began an investigation of a Texas physician accused of an FCA violation in 2017 and resolved the issue in 2023. The example is not uncommon, but each is different based on the facts and circumstances.
Even so, we can provide some generalities, so you have a better understanding of how these cases proceed.
Let’s break it down chronologically.
#1: The beginning
These cases often begin in one of two ways: the government discovers a discrepancy, or someone moves forward with allegations of wrongdoing. This is also known as a whistleblower or qui tam claim. It is important to note that individuals are highly incentivized to bring these cases forward. If their involvement results in a settlement or win for the government, they get a percentage of the winnings. This can mean a big cash bonus for bringing the information forward.
#2: The middle
The investigation will vary depending on how much evidence the team discovers. Although the investigation is supposed to conclude in 60 days, the government is allowed to request extensions. If they begin their investigation and everything appears to be in order, it could be a relatively quick process. If not, extensions may apply, and the government could spend months or even years gathering evidence and building their case.
In the example noted above, a whistleblower brought the claim forward, and the government chose to intervene. Although details of the case are not provided, they were likely able to get extensions to the 60 day time period due to evidence gathered during the ongoing investigation.
#3: The end
These cases are generally resolved in one of three ways: dismissal of the claim, settlement, or litigation. Although the investigation in the case above likely took more than the allotted 60 days, the overall length of the case was likely also due to negotiations and court filings.
Knowing the right option for your case will depend on the details of the allegations. An attorney experienced in this niche area of law can review your case and provide further guidance to better ensure your rights are protected throughout the process.
Attorney John Rivas is responsible for this communication.