The key factor in evaluating an FCA case is whether a whistleblower has evidence that fraud or other wrongdoing caused the federal government to suffer a financial loss. In recent decades, that primarily means fraud against the
Medicare or Medicaid programs, but would include a loss against any federal program, such as
procurement fraud against the Department of Defense, fraud in education that affects government-backed student loans, failing to pay royalties for mining or drilling on federal land, or fraud against various federally-backed insurance programs, including mortgage, crop, and flood insurance. These are just a few examples of affected programs; with federal spending representing nearly a quarter of GDP, the list is endless. Some common schemes include overcharging the government for a product or service, charging the government for a product or service that was never provided, providing the government with a product or service that is substandard or otherwise different from what the government agreed to pay for, or keeping an overpayment received from the government. In addition to proving that the government suffered a financial loss, it must be proven that a Defendant’s conduct was “knowing,” including deliberate ignorance or reckless disregard, but not including mere negligence. The law allows for a recovery of three times the amount of the government’s financial loss, known as “trebling,” as well as additional penalties for each false claim submitted to the government.