If you’ve discovered that your employer or a company you’re working with is defrauding the government, you may be wondering: What exactly counts as a “false claim” under the False Claims Act (FCA)? Understanding this definition is essential before moving forward with a whistleblower lawsuit. We’re grateful to the Law Offices of Darth M. Newman for their role in helping us explain this issue clearly.
The FCA doesn’t target every mistake or error. Instead, it focuses on knowingly deceptive conduct that leads the government to pay out funds it shouldn’t have or not receive funds it is owed. While that sounds straightforward, “false claims” can take many forms — some obvious, some highly technical.
The Legal Definition Of A False Claim
Under 31 U.S.C. § 3729, a false claim includes any of the following:
- Knowingly presenting a false or fraudulent claim for payment or approval
- Knowingly making or using a false record or statement to get a false claim paid
- Conspiring to commit any of the above
- Falsely certifying compliance with a contract or regulation as a condition of payment
- Improper retention of government overpayments or avoiding obligations to pay the government
Let’s break this down further by looking at what each of these can look like in practice.
Examples Of False Claims
- Billing for Services Not Rendered
A medical clinic bills Medicare for tests or procedures that were never performed, using a patient’s name and information. - Overcharging for Products or Services
A defense contractor inflates the cost of parts or labor beyond what was actually provided or agreed upon in the government contract. - Falsifying Eligibility Information
A company lies about its qualifications to receive SBA loans, grants, or COVID-19 relief funds, such as the Paycheck Protection Program (PPP). - Kickbacks and Unlawful Referrals
A pharmaceutical company offers illegal incentives to doctors to prescribe certain drugs reimbursed by Medicare or Medicaid. This taints the claims submitted, rendering them false. - Off-Label Marketing
A drug manufacturer promotes a drug for uses not approved by the FDA, causing providers to unknowingly submit false claims for reimbursement. - False Certifications
A contractor certifies compliance with safety regulations or minority-owned business requirements to qualify for federal contracts, when in fact they are noncompliant. - Retaining Overpayments
A healthcare provider discovers they’ve been overpaid by Medicaid but fails to report or return the funds within 60 days, as required by law.
What Does “Knowingly” Mean?
One of the most important — and often misunderstood — terms in the FCA is “knowingly.” Fortunately for whistleblowers, the law defines it broadly:
- Actual knowledge: The person or company knew the claim was false.
- Deliberate ignorance: They intentionally avoided learning the truth.
- Reckless disregard: They acted with blatant disregard for whether the claim was accurate.
This means the FCA does not require proof of intent to defraud. If a company is willfully blind to the truth or fails to establish proper systems for accurate billing, it can still be held liable.
Not Every Mistake Is Fraud
It’s important to understand that honest mistakes, clerical errors, or differences of opinion are not enough to support an FCA case. The law targets systemic, knowing fraud — conduct that is part of a deliberate effort to improperly obtain government funds or services.
This is why legal consultation is crucial. An experienced whistleblower lawyer can help assess whether the evidence and conduct you’ve observed rise to the level of an actionable false claim.
How Whistleblowers Help Expose False Claims
In many FCA cases, whistleblowers are the only ones who know the truth. You may be:
- An employee reviewing internal billing practices
- A contractor who has access to supply chain or compliance documents
- A competitor who learns of unlawful bidding behavior
When you file a qui tam lawsuit under the FCA, you help the government uncover and stop fraud — and you may receive 15% to 30% of the recovered funds as a reward.
False claims don’t always come with flashing red lights. They are often embedded in billing codes, invoices, certifications, and processes designed to appear legitimate. The FCA empowers insiders to bring these schemes to light, recover taxpayer money, and deter future fraud.
If you believe you’ve uncovered a false claim — whether it’s in healthcare, government contracting, education, or another federally funded industry — don’t wait. Contact our firm for a confidential consultation. We’re here to guide you through the process and help you build a strong case with confidence.