The type of cases filed as qui tam actions generally revolve around false claims that are either directly or indirectly presented to the Government for “payment or approval.” These false claims can be generated through the submission of false records, statements or other representations made to the Government.
The 1986 Amendment defines a “claim” as:
“…any request or demand which is made to a contractor, grantee, or other recipient if the United States Government provides any portion of the money or property which is requested or demanded, or if the government will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.”
Although the 1986 amendment covers a wide variety of fraudulent conduct under its definition of a false claim, the amendment does not cover false claims to the Government relating to tax returns.
Also unique to the 1986 amendment was the inclusion of what is known as “the reverse false claim” that covers fraudulent conduct of using a false record to reduce or decrease an obligation owed to the Government. An example would be a company falsely classifying certain products imported into the U.S. in order to avoid paying higher tariff amounts.
There are several general types of cases filed as qui tam actions. One is the mischarging case that is the most common type of case filed. Mischarging cases generally involve filing false claims for goods or services that were not provided or delivered. A common mischarging scenario is commercial charged to a government contract. Other common mischarging schemes are claims made to the Government for medical services not rendered or for services performed by an attending physician when the service was actually performed by a nurse or other provider that should have been billed at a lower rate.
Another type of case is the false negotiation or defective pricing case that involves the submission of false cost and pricing data to the Government. This scheme, which takes on many forms, involves the submission of false costs or pricing data to the Government during the negotiation of a contract that subsequently results in an inflated contract price.
Other common types of cases involve product and service substitution and false certification of entitlement for benefits. Examples of product and service substitution are falsely certifying that a product meets specifications, false testing schemes such as falsely certifying that reliability testing was conducted and providing an inferior service or product. Examples of false certification of entitlement cases are falsely certifying information for FHA mortgage guarantees and price supports.