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 which 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 employee labor charged to a government contract not worked on. 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.