FCA Now
Uncategorized
Is There FCA Risk in Your Public Data? DOJ Launches the “FOCUS” Initiative, Formalizing Engagement with Data Miner Relators
The U.S. Department of Justice’s (the “Department”) Civil Division recently announced a new anti-fraud initiative dubbed the Fraud Oversight through Careful Use of Statistics (FOCUS) initiative. FOCUS is designed to formalize the Department’s engagement with so-called “data miner” relators who file qui tam complaints under the False Claims Act (FCA). The announcement signals the Department’s intent to both leverage a fast-growing source of FCA litigation and discourage data-miner relators from filing actions that cannot overcome a motion to dismiss. It carries significant implications for government contractors, grant recipients, healthcare providers, lenders, importers, and other recipients of federal funds whose dealings with the United States leave a public data trail. The FOCUS Initiative FOCUS is a response to the explosion of FCA qui tam lawsuits in recent years, culminating in a record 1,297 qui tam complaints in FY 2025. In FY 2026, there have already been 780 qui tam lawsuits filed—putting us on pace for another record-setting year. Much of the surge has been driven not by traditional insider whistleblowers (e.g., current and former employees), but by companies and individuals analyzing publicly available government data for potential signals of fraud. Through FOCUS, the Civil Division seeks to provide guidance to would-be data-miner relators to ensure that their qui tam complaints are worthy of civil prosecutors’ time and have the potential of withstanding a motion to dismiss. Civil Fraud Section prosecutors will meet with data miners to assess their analytical capabilities, validation methods, and the reasons their data signals reliably correlate to actionable fraud. These pre-filing meetings are voluntary, not a precondition to filing. But the Department has signaled that it will preferentially work with data miners that demonstrate an investment in pre-filing diligence, analytical rigor, familiarity with program rules, and legally sufficient allegations. This may be another part of the Department’s broader interest in weeding out unmeritorious qui tam actions quickly, and potentially even seeking their dismissal. Background: The Rise of the Data-Miner Relator The traditional FCA relator is an industry insider: a former employee, contractor, vendor, or consultant with firsthand knowledge of alleged misconduct. The 1986 amendments to the FCA were structured around that paradigm, with bounty incentives of 15% to 30% of any recovery designed to encourage insiders to come forward. Over the last decade, however, a different model has emerged: “whistleblowers” who identify potential fraud solely through pattern analysis of publicly disclosed government data. Data-miner relators typically rely on large federal data sets, including Medicare and Medicaid claims data published by the Centers for Medicare & Medicaid Services, Paycheck Protection Program (PPP) loan disclosures by the Small Business Administration, customs and trade data, and federal grant and contract award databases. The data miners apply statistical analyses, or, increasingly, machine-learning and AI tools, to flag anomalies or connections in the data that suggest fraud. PPP loans have been a particularly active driver of recent filings, with data miners cross-referencing SBA loan data against company filings, state corporate registries, news media, company websites, and other public sources to identify potential affiliation, headcount, or eligibility issues. Mixed Results in the Courts Data-miner relators have faced two structural defenses. First, the FCA’s public disclosure bar, 31 U.S.C. § 3730(e)(4), precludes qui tam suits substantially based on certain public disclosures unless the relator is an original source. Second, Federal Rule of Civil Procedure 9(b)’s requirement that fraud be pleaded with particularity, which applies to FCA claims, has proven difficult to satisfy for data miners, where statistical inference is their primary tool. The leading appellate decisions reflect judicial skepticism of “stats without facts” pleadings. For example, the Ninth Circuit reversed the denial of a motion to dismiss where the relator, a self-described data analytics company with no insider knowledge, relied on statistical analyses of CMS claims data to allege a Medicare upcoding scheme.1 The court held the data-miner relator had offered only a possible explanation for billing patterns that were equally consistent with a plausible, lawful alternative explanation, and therefore failed to cross the line from possibility to plausibility under Iqbal and Twombly. The Fifth Circuit reached a similar conclusion holding that statistical data cannot satisfy Rule 9(b) where it is equally consistent with a legal and obvious alternative explanation.2 The government has pushed back against opportunistic professional relators. In United States ex rel. CIMZNHCA, LLC v. UCB, Inc., the Department moved to dismiss a qui tam filed by an entity organized specifically for that qui tam action and by an organization that had established nearly a dozen other entities to pursue parallel Anti-Kickback Statute–based FCA cases against pharmaceutical manufacturers.3 The Department argued the cases lacked sufficient merit to justify the cost of investigation and were contrary to the public interest. The Seventh Circuit ultimately reversed the district court’s denial of the motion, observing that the FCA was not designed to operate as an investment vehicle for financial speculators. But the caselaw cuts both ways. Where data miners have invested in genuine pre-filing investigation, supplemented public data with non-public information, or tied their analyses tightly to documented program requirements, courts have allowed suits to proceed past the pleading stage, and the Department has occasionally even intervened. PPP-related qui tam actions brought by data miner entities have produced significant recoveries and are principal drivers of the FY 2024 and FY 2025 surge in qui tam filings. What the FOCUS Initiative Signals Read against this backdrop, FOCUS reflects a few policy choices. First, the Department is embracing the data-miner relator model. The Civil Division could have responded to the qui tam surge by pressing for more restrictive judicial constructions of the public disclosure bar or by expanding its use of dismissal authority under 31 U.S.C. § 3730(c)(2)(A). Instead, the Department is opening a formal channel for engagement, on the premise that the most sophisticated analytics partners may surface from the ocean of data frauds the Department or other whistleblowers might otherwise miss. Second, the Department intends to triage and filter. By prioritizing data miners that can articulate validation methods, demonstrate pre-filing diligence, and show familiarity with program rules, the Department is implicitly distinguishing rigorous data miners from less sophisticated and more opportunistic ones. Cases built on raw statistical outliers without supporting facts, like the model the Fifth and Ninth Circuits have rejected, may be less likely to merit DOJ attention (or intervention). The Department has recently expressed increased interest in discouraging unmeritorious qui tam actions. FOCUS may be a significant component of that effort given the number of data-miner relator qui tam actions. Through FOCUS, DOJ cautions data-miner relators that they must: “provide valuable leads through high-quality, reliable, and predictive data analyses and signals and a thorough understanding of the relevant legal obligations”; “state with particularity the circumstances constituting fraud” under Rule 9(b); “assess potential alternative explanations for the observed conduct” and “articulate . . . both scienter and falsity”; and demonstrate “program eligibility requirements and relevant regulatory frameworks.” Third, FOCUS complements the Department’s broader fraud-enforcement trends. With FCA recoveries setting a record at $6.8 billion in FY 2025, the cross-agency Trade Fraud Task Force ramping up tariff- and customs-related FCA enforcement, the Civil Cyber-Fraud Initiative continuing to mature, and DEI-related civil rights FCA initiatives recently announced, FOCUS adds yet one more effort toward the Department’s FCA enforcement push. Considerations for FCA-Exposed Organizations For organizations that directly or indirectly receive federal funds, news of the FOCUS Initiative reinforces the need to monitor developments in FCA enforcement and continue to invest in robust compliance programs. A few practical implications are worth highlighting: Public data is potential enforcement data. Data an organization submits to or generates for the federal government, such as claims data, loan applications, customs entries, payroll certifications, grant certifications, and many others, may be or may soon be accessible to data-miner relators. That is a key risk vector, but also an opportunity, as organizations can pressure-test internal data against the same kinds of analyses third parties run externally, including outlier and anomaly detection on billing, pricing, and reporting data. Documentation of legitimate variation could be a difference maker. The Fifth and Ninth Circuits’ rejections of data-miner relator FCA theories rested largely on the Courts’ willingness to credit lawful alternative explanations for statistical outliers. Organizations that can document why their billing, coding, payroll, or pricing patterns may differ from peers, such as because of case mix, geography, business model, regulatory interpretation, or other lawful drivers, may be substantially better positioned if a data miner’s complaint is unsealed or DOJ opens an investigation. The value of pre-CID self-assessment and self-disclosure may be increasing. Once the Department engages with a data-miner relator through FOCUS, the path from analytic insight to civil investigative demand may be shorter than under the traditional insider-driven model. When an organization’s internal review surfaces genuine compliance issues, particularly in current Department priority areas, such as Medicare Advantage risk-adjustment coding, PPP eligibility and forgiveness, customs valuation and country-of-origin, and cybersecurity certifications, early voluntary disclosure and remediation could meaningfully affect resolution outcomes. Dorsey’s Government Solutions and Investigations Practice Group counsels and represents organizations that received federal funds, including government contractors, government grantees, healthcare providers, financial institutions, and other recipients, on FCA risk, response to HHS-OIG subpoenas, FCA civil investigative demands, defense of qui tam litigations, and compliance programs. Please contact the authors or your Dorsey relationship attorney with questions about how the FOCUS initiative may affect your organization. 1 United States ex rel. Integra Med Analytics, LLC v. Providence Health & Servs., 854 F. App’x 840 (9th Cir. 2021). 2 United States ex rel. Integra Med Analytics, LLC v. Baylor Scott & White Health, 816 F. App’x 892 (5th Cir. 2020). 3 United States ex rel. CIMZNHCA, LLC v. UCB, Inc., 970 F.3d 835 (7th Cir. 2020).
May 4, 2026
Uncategorized
Department of Justice Launches “Civil Rights Fraud Initiative” to Target DEI Through False Claims Act
On Monday, May 19, 2025, Department of Justice (“DOJ”) Deputy Attorney General Todd Blanche issued a memorandum establishing the “Civil Rights Fraud Initiative” (the “Memorandum”), in the latest signal that DOJ intends to aggressively enforce the False Claims Act in pursuit of the administration’s goals. According to the Memorandum, DOJ has launched a joint enforcement effort between the Civil Division’s Fraud Section (“Civil Frauds”) and the Civil Rights Division (“Civil Rights”), which “will utilize the False Claims Act to investigate and, as appropriate, pursue claims against any recipient of federal funds that knowingly violates federal civil rights laws.” The Memorandum signals that DOJ intends to adopt a dramatically different interpretation of federal contractors’ and federal funds recipients’ civil rights obligations from prior administrations. For instance, the Memorandum specifically identifies universities that receive federal funding as potential targets of the Civil Rights Fraud Initiative, and outlines four examples of conduct that “could violate the False Claims Act:” “Encourag[ing] antisemitism,” though neither term is defined; “Refus[ing] to protect Jewish students;” “Allow[ing] men to intrude into women’s bathrooms;” or “Requir[ing] women to compete against men in athletic competitions.” The Memorandum also re-emphasizes that Diversity, Equity, and Inclusion (“DEI”) initiatives are an enforcement priority for DOJ. Citing to Executive Order 14173, Ending Illegal Discrimination and Restoring Merit-Based Opportunity, the Memorandum reiterates that certifying compliance with civil rights laws while “knowingly engaging in racist preferences, mandates, policies, programs, and activities, including through [DEI] programs that assign benefits or burdens on race, ethnicity, or national origin,” also implicates the False Claims Act. The Civil Rights Fraud Initiative may extend beyond mere civil liability. The Memorandum provides that both Civil Frauds and Civil Rights will “engage with” DOJ’s Criminal Division. The Memorandum also encourages qui tam litigation as a means to achieve DOJ’s goals. What Happens Next? It is highly likely that in the coming weeks and months, DOJ will issue Civil Investigative Demands (“CIDs”) to an increasing number of universities, public school districts, contractors, grant recipients, and other entities that receive federal funds. CIDs essentially act as subpoenas to facilitate investigation of potential False Claims Act violations, and based upon the priorities outlined in the Memorandum, such CIDs will likely demand information, documents, or interviews related to DEI, antisemitism, and trans-inclusivity policies, practices, programs, and activities. It is similarly likely that such investigative and/or litigation activity will result in courts being asked to decide whether the administration’s interpretations of federal civil rights obligations are consistent with the law. There is reason to suspect that courts may be skeptical of the administration’s application of the law, as even the examples articulated in the Memorandum could be read to contradict Supreme Court precedent on the scope of “sex discrimination” under Bostock v. Clayton County, 590 U.S. 644 (2020), which held that Title VII of the Civil Rights Act of 1964 protects employees against discrimination based on sexual orientation or gender identity. In the meantime, however, many recipients of federal funds will likely be subject to extensive investigative efforts and potential litigation based upon DOJ’s new Civil Rights Fraud Initiative. What Federal Fund Recipients Should Do Now The Memorandum marks the latest and most concrete signal that DOJ intends to leverage the False Claims Act to target institutions of higher education, contractors, and others that do business with the federal government that the administration alleges violate civil rights laws. Although the False Claims Act’s statute of limitations extends between six and ten years, federal fund recipients can and should take immediate steps to (i) reduce the likelihood that they become the target of a federal investigation; and (ii) assess and limit the scope of liability if such an investigation does occur. For instance, organizations should: Conduct a thorough review of all DEI-related policies and practices to ensure that practices and programs do not differentiate based on protected characteristics. This can include hiring, employee resource groups, contracting, grant funding, university admissions, and much more. Assess current practices as they relate to religion-based harassment and speech. Now is the time to determine if your policies and practices make clear that religion-based harassment or discrimination are appropriately prohibited and responded to. For institutions of higher education, policies should strike a careful balance between permitting the free expression of students, faculty, and staff, and ensuring that others are free from discriminatory harassment. Analyze bathroom, athletics, and other trans-inclusive policies to determine the scope of potential risk, and if there are changes that could be made to reduce risk consistent with your organization’s goals. If your organization receives a Civil Investigative Demand, closely review it and ensure that you understand the scope of it—including understanding that receipt of a CID likely indicates an active civil fraud investigation against the organization. In addition, depending on past practices and the scope of federal funds received, some recipients of federal funds may benefit from a preemptive review of past and current policies and practices to determine exposure, if any, to potential False Claims Act liability. The False Claims Act provides for treble damages plus penalties to the federal government, but DOJ has given credit for self-disclosure and cooperation when entities proactively disclose potential violations. Federal fund recipients should consider whether such a review and potential disclosure could be in their best interests.
May 22, 2025
Healthcare
DOJ Intends to “Aggressively” Enforce the False Claims Act During Second Trump Administration
Deputy Assistant Attorney General Michael Granston laid out the Department of Justice’s (“DOJ”) priorities over the next four years at the Federal Bar Association’s annual qui tam conference in Washington, D.C. last week. In his keynote address, Granston dispelled any notions that False Claims Act (“FCA”) enforcement would be curtailed, saying that DOJ “plans to continue to aggressively enforce the False Claims Act” consistent with the new administration’s focus on achieving government efficiency and rooting out waste, fraud and abuse. What are DOJ’s priorities? Granston went on to identify several key priorities for FCA enforcement in the coming years, including: Tariff Evasion/Customs Fraud. Granston stated that the FCA is a “powerful tool” for fighting against efforts to avoid paying customs duties on imported goods. Given the Administration’s focus on trade issues, “reverse false claims” actions challenging goods classifications under the Harmonized Tariff Schedule, country of origin, or product value, and similar FCA claims may increase significantly in the coming months and years. Pharmaceutical Price Inflation and Drug Rebate Retention. Artificial inflation of pharmaceutical prices for government healthcare programs (including Medicare, Medicaid, FEHB, and TRICARE) resulting in increased costs to the federal government, such as through manipulating the reported “Average Wholesale Price” (AWP), may create FCA liability. Similarly, Part D Plan Sponsors, or pharmacy benefit managers, are obliged to pass on certain savings, including discounts and rebates, to the federal government. These savings are also reported, creating the risk for FCA liability in the obligation to pass savings through and the reporting requirements. Procurement Fraud. DOJ has made it clear this will be another area of focus. Government contract awards based on false premises or promises in a proposal or bid, false certifications, bid rigging, collusive behavior, and other similar alleged conduct are expected to be a focus over the next year. In a similar vein, the U.S. Attorney’s Office for the Northern District of Ohio last month announced it would be “spearheading a new, interagency Supply Chain Oversight and Procurement Enforcement (SCOPE) Task Force . . . to ensure supply chain integrity and prevent procurement fraud.” Medicare Part C/Medicare Advantage. Medicare Part C, also known as Medicare Advantage, constitutes about half of all expenditures for the Medicare program and affects millions of beneficiaries. Granston indicated that DOJ intends to ramp up enforcement of Part C fraud, which may include claims of provision of substandard or unnecessary care, “upcoding” schemes, and false certifications. Pandemic Relief. Over recent years, DOJ has dramatically increased its enforcement related to pandemic relief, including Paycheck Protection Program (PPP) based fraud. According to Granston, this is likely to continue for the foreseeable future. The Administration has offered broader signals of its own, particularly given the high-profile activities of the Department of Government Efficiency, and multiple broad-reaching Executive Orders focused on institutions of higher education and research institutions. Federal grants compliance, particularly as to DEI/DEIA initiatives (see related discussion here and here) and the interaction between certifications of compliance and the FCA may be a major focus for DOJ and private relators. How should organizations prepare? If you or your organization are receiving federal funds or could be obligated to make non-tax payments to the federal government (such as tariffs), mitigation of the risk of FCA liability and related investigations are prudent. Review current practices with an eye to the FCA. With DOJ signaling that “aggressive” enforcement of the FCA is ahead, organizations making payments to or receiving payments from the federal government for anything from paying import duties to submitting claims for medical services, should review current practices and policies to identify areas of risk and bolster their culture of compliance. Analyze your federal-facing data. From import records to healthcare claims payments, many organizations knowingly or unknowingly provide the federal government with treasure troves of information. Knowing what your own data says about your organization can help you get ahead of any potential federal investigation. Consult with counsel. The best time to get ahead on FCA issues is before they arise. Proactive assessments, mitigation, and even self-disclosure with the help of experienced counsel can significantly reduce FCA exposure. Certainly, if a Civil Investigative Demand drops on your desk, pick up the phone and get some expert help.
February 27, 2025
Settlements
DOJ: Whistleblowers Filed Highest Number of FCA Cases Ever and Settlements and Judgments Exceeded $2.9 Billion in FY 2024
The U.S. Department of Justice (DOJ) recently released the fiscal year (FY) 2024 (October 1, 2023 – September 30, 2024) statistics on qui tam and non-qui tam actions under the False Claims Act, 31 U.S.C. § 3729, et seq. (FCA). Relator whistleblowers filed the highest number of FCA actions ever, totaling 979 new qui tam actions. Settlements and judgments exceeded $2.9 billion, of which $2.4 billion arose from qui tam actions. And Relator shares of settlements and judgments exceeded $400 million for the third year running. Health care fraud settlements and judgements alone surpassed $1.67 billion and represented approximately 58% of the total settlement and judgment recoveries—DOJ noted that total does not include recoveries for state Medicaid programs. Two settlements that arose from alleged wrongdoing contributing to the opioid epidemic accounted for approximately $875 million of that total. But with respect to health care, DOJ pointed to several other settlements arising from allegations of substandard care or provision of unnecessary services, and affirmed its continued efforts related to Medicare Advantage fraud and unlawful kickbacks. Although health care fraud remains the largest source of FCA recoveries, DOJ’s report details several high-value settlements and judgements in military procurement fraud, PPP loans, and failures to meet cybersecurity requirements in government contracts, emphasizing the wide breadth of the FCA. In addition, pandemic relief fraud is still a significant area of enforcement for DOJ, accounting for 250 of the settlements and judgments and more than $250 million in recoveries. DOJ reaffirmed its commitment to “fighting fraud and abuse in federal programs,” and its focus on “health care fraud, the opioid epidemic, fraud in pandemic relief programs, and violations of cyber security requirements in government contracts and grants.” DOJ, as it does in other contexts, continues to promote cooperation of defendants in FCA investigations and litigations. According to DOJ, self-disclosure, “demonstrabl[e]” cooperation, and remedial measures, inure to defendants’ benefit through acknowledgement in settlement agreements, and reduced penalties or damage multiples. Organizations that discover internal fraud concerns, facing FCA Civil Investigative Demands, or defending against FCA actions must weigh and consider carefully how to approach self-disclosure and cooperation, from day one through the end of the action. Deputy Assistant Attorney General for the Commercial Litigation Branch Michael Granston is expected to speak next month at the Federal Bar Association’s Qui Tam Conference. DOJ may provide more detail on its enforcement priorities then, which may shift given the change of Administration. FCA-enforcement actions do not appear likely to decline, though, given President Trump’s nominee for Attorney General, Pam Bondi, said during her Senate confirmation hearing that DOJ would defend the constitutionality of the FCA in court and recognized the significance of the FCA as a means of “protection” from fraud and for “the money it brings back to our country.”
January 28, 2025
Enforcement
Supreme Court’s Recent Decision on FCA’s Scienter Standard Potentially Raises Threshold for Government to Establish “Reckless Disregard”
On June 1, 2023, a unanimous Supreme Court decision sought to clarify the meaning of “scienter” in the FCA context, which deals with the defendant’s knowledge (or lack thereof) that a claim for payment was false and intent to submit the false claim. See United States ex rel. Schutte v. SuperValu Inc., 143 S. Ct. 1391 (2023) (“SuperValu”). There, the Court ruled that “[f]or scienter, it is enough if respondents believed that their claims were not accurate.” Id. at 1404. According to the SuperValu decision, only that subjective belief as to the claim’s falsity matters, and whether there is an “objectively reasonable” explanation for the false claim is irrelevant. Id. at 1399 (“The FCA’s scienter element refers to respondents’ knowledge and subjective beliefs—not to what an objectively reasonable person may have known or believed.”). While explaining the basis for the decision, Justice Thomas wrote that “the FCA’s standards focus primarily on what respondents thought and believed,” discussing how the three different FCA knowledge standards—actual knowledge, deliberate ignorance, and reckless disregard—each rely on the defendant’s subjective knowledge. Id. at 1400-01. Describing “reckless disregard” in the FCA context, Justice Thomas explained that the term “captures defendants who are conscious of a substantial and unjustifiable risk that their claims are false, but submit the claims anyway.” Id. That sentence is already being used to argue that SuperValu heightened the government’s burden when it is attempting to prove reckless disregard—that to establish reckless disregard the government must show that the defendant was, as Justice Thomas described, “conscious of a substantial and unjustifiable risk that their claims are false.” If courts rely on this as the standard for establishing reckless disregard in the future, it could heighten the government's burden as compared to tests currently used by courts. For example, in July 2022 the Middle District of Georgia described the reckless disregard standard in the FCA context as when the defendant “knows or has reason to know of facts that would lead a reasonable person to realize that harm like a false claim is the likely result of the relevant act.” United States ex rel. Hockaday v. Athens Orthopedic Clinic, P.A., 616 F. Supp. 3d 1339, 1354 (M.D. Ga. 2022) (quoting Urquilla-Diaz v. Kaplan Univ., 780 F.3d 1039, 1058 (11th Cir. 2015)) (cleaned up). As one example of how defendants are already using the Court’s language, in a June 23 brief to the Western District of Virginia District Court discussing the impact of the SuperValu decision, the defendants in the Miller case contended that “[t]he Supreme Court clarified that the FCA’s ‘reckless disregard’ standard ‘captures defendants who are [1] conscious of a [2] substantial and [3] unjustifiable risk that their claims are false, but submit them anyway.’” See, e.g., United States ex rel. Miller v. Reckitt Benckiser Group PLC, 1:15-cv-00017, Dkt. No. 149 at 10-11 (W.D. Va. July 7, 2023). DOJ responded that there is no three-part test to establish reckless disregard, and instead the effect of the SuperValu decision is simply rejecting any argument that the FCA’s scienter element incorporates an objective test. Id., Dkt. No. 150 at 3. According to DOJ, the Court was not “establishing new and restrictive criteria” to show reckless disregard, but was merely “summarizing” existing case law. Id. The Western District of Virginia has not yet made a ruling relevant to these arguments, but the eventual ruling will be one of the first to test a potential new argument available to FCA defendants resulting from the SuperValu decision, and may provide an additional hurdle for the government to prove reckless disregard.
August 10, 2023
COVID-19
Justice Department Annual Release Shows Decreased FCA Recoveries But Increased FCA Matters in FY2020, Suggesting Likely Uptick in 2021
On January 14, 2021, the United States Department of Justice (“DOJ”) issued its annual press release highlighting its recoveries from False Claims Act (“FCA”) enforcement over the last fiscal year. Total recoveries in FY2020 exceeded $2.2 billion, with the majority—$1.8 billion—of those recoveries coming from the healthcare industry. These totals are down substantially from FY2019, in which total recoveries exceeded $3 billion with $2.6 billion relating to matters involving the health care industry. As was the case last year, recoveries from qui tam actions—lawsuits brought by whistleblowers or “relators” suing on behalf of the government—continued to fall, with only $1.6 billion in recoveries coming in qui tam actions following $2.2 billion in FY2019. As we noted last year, this is unsurprising given former Attorney General Barr’s well-documented distaste for the qui tam provisions of the FCA, calling them “patently unconstitutional” in a memo he wrote as an Assistant Attorney General in 1989. It also highlights the continuing effect of the “Granston Memo” on qui tam enforcement. The Granston Memo, issued in 2018, instructed DOJ prosecutors to dismiss qui tam cases that lack substantial merit on the grounds that meritless qui tam cases drain limited government resources and may “generate adverse decisions that may affect the government’s ability to enforce the FCA.” But the most likely factor for the lower recoveries in FY2020 is, of course, COVID-19, which has slowed judicial proceedings around the country and undoubtedly affected the progression of qui tam suits—an issue quickly identified by the DOJ in qualifying its reduced recoveries. The COVID-19 factor that led to a decrease in recoveries in FY2020, however, is likely to be responsible for what is expected to be a substantial increase in FCA recoveries and enforcement in 2021. First, the government’s response to the pandemic by injecting trillions into the economy has created massive FCA exposure. The risk of civil enforcement actions to combat fraud relative to the government’s expenditures are just starting to be seen now, with the recent announcement of the first civil FCA settlement based on a Paycheck Protection Program (“PPP”) loan. Many more settlements and actions are likely to follow, given the congressional authorization of nearly $1 trillion of PPP funding since March 2020. The rate of these enforcement actions is likely to increase, too, as the vaccine rollout continues and courts resume normal activities. Moreover, the government will be able to more effectively investigate and resolve FCA matters as the pandemic subsides, including addressing not only the new cases filed in 2021, but also, the still-pending 2020 matters. Notably, although the total recoveries and total qui tam recoveries for FY2020 were down as compared to FY2019 ($2.2/1.6 billion compared to $3/2.2 billion), the total number of new FCA matters increased. In FY2019, there were a total of 786 new FCA matters (148 non-qui tam and 638 qui tam). This number increased by nearly 17% in FY2020, with 922 new FCA matters reported (250 non-qui tam and 672 qui tam). Thus, as the government is able to better investigate these lingering 2020 matters in FY2021, the recoveries that may have otherwise been realized in FY2020 are now more likely to be realized in FY2021. Second, COVID-related expenditures—and the associated FCA exposure—are only expected to increase after President-Elect Biden proposed a $1.9 trillion relief plan on January 14, 2021. Although a large percentage of that sum will go to individuals and the vaccine program, hundreds of billions are likely to go to businesses, opening the door for more fraud. Finally, the Biden administration may be more willing to pursue qui tam suits than the Trump administration, leading to an increased number of qui tam actions and a corresponding increase in overall recoveries. President-Elect Biden stated plans to nominate Merrick Garland as Attorney General, who does not appear to have taken the same strong position against qui tam suits as seen with former Attorney General Barr. In short, while FY2020 was a down year for FCA recoveries, the number of total new FCA matters increased, and the conditions are ripe for a rise in FCA enforcement actions and recoveries throughout 2021.
January 19, 2021
COVID-19
Borrowers and Banks Beware: The New Year Brings the Nation’s First False Claims Act Settlement for Paycheck Protection Program Fraud
On January 12, 2021, the Eastern District of California entered into a civil settlement with a Paycheck Protection Program (“PPP”) borrower and its CEO to resolve allegations of fraud. The settlement stemmed from a $350,000 PPP loan that SlideBelts Inc., an internet retail company, received even though it was a prohibited borrower as a debtor in bankruptcy. This is the first civil settlement for PPP-related fraud and is a harbinger of what the New Year will bring for some of the five million PPP loan recipients to date. The Settlement According to the settlement agreement, SlideBelts submitted three applications for PPP loans to three different lenders on April 3, 8, and 14 of 2020. The application forms (SBA Form 2483) provide that loans will not be approved for any applicant that provides an affirmative answer to the very first question on the form, which asks: 1. Is the Applicant . . . presently involved in any bankruptcy? Even though it was a debtor in a Chapter 11 bankruptcy at the time, SlideBelts answered “no” to this question in each of its three applications. The settlement agreement provides the first lender rejected SlideBelts’ application on April 10, 2020. At that time, the first lender sent an email advising SlideBelts’ CEO, Brigham Taylor, that Question 1 had been answered incorrectly because the lender knew SlideBelts was presently in bankruptcy. Taylor responded that the answer was an “oversight,” but asserted that the question regarding bankruptcy was “an overreach” by the Small Business Administration (“SBA”). On April 14, 2020, Taylor wrote the first lender again and reiterated that the term “bankruptcy” should not be included in Question 1, and that the lender should approve the loan. The lender rejected Taylor’s request and repeated that SlideBelts was not eligible for a PPP loan because it was in bankruptcy. Three hours later, SlideBelts submitted the third application, signed by Taylor, to a different lender. Shortly thereafter, the second lender approved SlideBelts’ second application. Taylor signed the loan note with the second lender and, according to the settlement agreement, again “stated falsely that SlideBelts was not in bankruptcy to influence [the second lender] to execute the note and disburse the [$350,000] loan proceeds to SlideBelts.” As a result of the note and the false statements by Taylor and SlideBelts, the second lender not only disbursed the loan proceeds to SlideBelts on April 21, 2020, but also submitted a false claim to the SBA for $17,500 in loan processing fees, which the SBA paid. One day after the loan was disbursed, Taylor wrote an email to the second lender stating that SlideBelts “just realized that we may not have answered [Question 1] correctly since we filled out the application quickly and wanted to bring it to your attention.” Instead of returning the loan, however, SlideBelts sought retroactive approval of the PPP loan from the bankruptcy court. In doing so, SlideBelts did not disclose to the bankruptcy court that it had obtained the loan by making a false statement to the second lender regarding its status as a debtor in bankruptcy. The SBA and the second lender opposed SlideBelts’ motion and requested that the bankruptcy court order SlideBelts to return the loan. SlideBelts did not return the money voluntarily but instead asked the bankruptcy court to dismiss the case so that it could refile for bankruptcy later and apply for a PPP loan while the case was dismissed. On June 30, 2020, the bankruptcy court granted SlideBelts’ motion to dismiss the bankruptcy case. After repeated demands from the SBA to return the proceeds, SlideBelts finally returned the $350,000 to the second lender on July 8, 2020. Based on these actions, the United States contends in the settlement agreement that SlideBelts and Taylor are liable to the government for damages and penalties totaling $4,196,992 for violations of the Financial Institutions Reform, Recovery, and Enforcement Act (“FIRREA”) and the False Claims Act (“FCA”). Pursuant to the terms of the settlement agreement, SlideBelts and Taylor agree to pay $100,000 to resolve these claims, with nearly half to be paid within fourteen days and the remaining amount due over the course of five years. Notably, the settlement amount “represents the amount the United States is willing to accept in compromise of its civil claims arising from the [alleged violations] due solely to the [Taylor and SlideBelts’] financial condition.” SlideBelts also agreed that if it failed to make its required payment under the settlement agreement, SlideBelts would consent to the entry of judgment against it for $2,098,496 (representing its half of the $4,196,992 in total alleged damages and penalties). The Takeaway When Congress enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act to quickly authorize up to $349 billion in forgivable loans to small businesses on March 29, 2020, it was inevitable that fraud would follow. Enforcement followed, too, with federal prosecutors pursuing dozens of criminal prosecutions for various PPP-related fraud throughout 2020. Those criminal charges often represented the most blatant of crimes and the easiest of targets. All the while civil lawsuits were quiet, or at least not yet public. But not anymore. This first-of-its-kind civil settlement demonstrates that civil enforcement actions are alive and well and that the government is aggressively pursuing recoveries against companies and individuals, and even against insolvent borrowers. (Indeed, even under pandemic circumstances, the DOJ reported recovering more than $2.2 billion in settlements and judgments from civil cases involving fraud and false claims against the government in fiscal year 2020.) Moreover, the settlement paves the way for private relators looking to take advantage of the qui tam provisions of the FCA to target PPP fraud. In fact, relator-driven qui tam cases—many of which are likely currently pending but under seal while under investigation by the government—may in fact dominate the enforcement scene related to PPP fraud in the New Year. Only time will tell, but at the least the SlideBelts settlement marks the beginning of a new chapter related to combatting pandemic-related fraud with civil enforcement actions and the FCA. To stay up-to-date on False Claims Act news, subscribe to Dorsey’s FCA Now Blog today.
January 14, 2021
COVID-19
Looking Ahead: Enforcement Actions for Fraud, Waste, and Abuse Related to COVID-19
As the public health and economic responses to COVID-19 dominate the headlines and traditional government enforcement actions slow, anticipate a significant increase in government enforcement actions, internal investigations related to corporate fraud, and qui tam (whistleblower) actions in the coming months. The CARES Act contains appropriations for tens of millions of dollars for agency inspector general enforcement. Leaders in federal law enforcement are telling us they are shifting enforcement priorities to target individuals and businesses for fraud, waste, and abuse related to COVID-19. This effort will last for years given the trillions of government dollars now pouring into the economy. These investigations will focus on decisions and actions (or inactions) being made now. Organizations must be looking to mitigate risk now. Current Enforcement Picture – Scams, Statement Prosecutions, and Snake Oil State law enforcement authorities are forming task forces to combat fraud, waste, and abuse related to COVID-19. Prosecutions will initially focus on fraudsters and price gougers seeking quick gains. Arizona and Georgia are among the latest to form such task forces, joining many others, including Nevada, South Carolina, New Jersey, Pennsylvania, Kentucky, and Louisiana. They are also already producing results. On April 9, for example, Georgia announced its task force arrested a woman for illegally selling an unregistered pesticide as a cure for the coronavirus. The task forces are joint operations between state and federal agencies, which is unsurprising given the specialized knowledge of state investigators and Attorney General William Barr’s direction to every U.S. Attorney’s Office on March 16 “to prioritize the detection, investigation, and prosecution of all criminal conduct related to the current pandemic.” The Department of Justice has also created at least one nationwide federal law enforcement task force. In a March 24 Memorandum Attorney General Barr announced the creation of the “COVID-19 Hoarding and Price Gouging Task Force.” This task force announced on April 10 the arrest of a man for wire fraud for attempting to sell $750 million in nonexistent personal protective equipment to the Department of Veteran Affairs. In a March 16 letter, the National Whistleblower Center encouraged Attorney General Barr to form additional nationwide task forces, including a task force to monitor and investigate COVID-19 related False Claims Act allegations. Small Businesses and Shareholders On March 27, the CARES Act made $350 billion available in loans to small businesses under the Paycheck Protection Program (PPP). The SBA made it clear in its Interim Final Rule that the applications, and hence the money, would be available on a “first-come, first-served” basis. The SBA approved the final loan application form on March 31, and small businesses scrambled to submit applications beginning April 1. The PPP loan application for borrowers requires small businesses—i.e., generally fewer than 500 employees—to certify their eligibility as a small business. Numerous businesses may run afoul of SBA’s affiliation rules, which prevent large organizations consisting of multiple small affiliated businesses from qualifying for loans intended for small businesses. Organizations that falsely certify their small business status for federal funding are at risk for substantial penalties under the False Claims Act and other Federal enforcement statutes. The risk is especially great here given the pressure on businesses to submit applications, the ambiguity of the loan program guidance and application materials, and the current financial pressures. These same organizations will be under extreme financial pressure in the future to request loan forgiveness. For example, the loan application requires the applicant to certify that they “understand that loan forgiveness will be provided for the sum of documented payroll costs, covered mortgage interest payments, covered rent payments, and covered utilities, and not more than 25% of the forgiven amount may be for non-payroll costs.” It also requires the applicant to submit supporting documentation relative to such costs for the eight-week period following the loan. The pressure to obtain maximum loan forgiveness will be great. The SBA, too, has announced in its Interim Final Rule that any shareholder, member, or partner of a small business that uses PPP funds for unauthorized purposes will be subject to liability for fraud. Task forces and whistleblowers and will be watching. Banks and Lenders Predatory lending practices also peak in times of crisis. Some lending institutions will exploit American consumers to survive financially, and in the worst cases, to make substantial profits. Consumer protection groups working with task forces are investigating these practices. Legislators are encouraging regulators to implement rules to protect vulnerable consumers from high interest rates. Agencies are already paying attention: the SBA is on alert for such frauds and limits the fees a broker can charge a borrower to 3% for loans $50,000 or less and 2% for loans $50,000 to $1,000,000 with an additional ¼% on amounts over $1,000,000. The False Claims Act—and its qui tam whistleblower provision—presents significant risk for lenders and banks participating in the federal stimulus programs. For example, the PPP loan applications require the borrower to certify “acknowledge[ment] that the lender will confirm the eligible loan amount using required documents submitted.” But underwriting loans, where time is short and the desire to help borrowers is extremely high, may lead in hindsight to questionable loan acceptances. Law enforcement may pursue lenders for recklessly disregarding false statements in loan applications. Qui tam actions are inevitable. Hospitals and Medical Providers When the CARES Act was signed into law on March 27, it allotted $100 billion in relief funds specifically to hospitals and other healthcare providers on the front lines of the pandemic. On April 10, as part of the “CARES Act Provider Relief Fund,” the U.S. Department of Health & Human Services (HHS) distributed $30 billion of these allotted funds to eligible providers. Payments to providers are based on their share of total Medicare fee for service reimbursements in 2019. The payments are not loans, they are not to be repaid, and they are being automatically deposited into provider accounts via direct deposit. Providers must sign an attestation, within thirty days of receiving the payment, confirming receipt of the funds and agreeing to HHS’s terms and conditions of payment. These terms and conditions include a certification from the provider “that the Payment will only be used to prevent, prepare for, and respond to coronavirus, and shall reimburse the Recipient only for health care related expenses or lost revenues that are attributable to coronavirus.” In addition, the terms and conditions require the provider to certify “that it will not use the Payment to reimburse expenses or losses that have been reimbursed from other sources or that other sources are obligated to reimburse.” Providers receiving other federal stimulus loans for similar relief, such as PPP loans for small business providers, may be targets of qui tam relators under the False Claims Act. Task forces and relators will examine data months and years from now for anomalies and evidence of double dipping. Retail Stores, Wholesalers, and Suppliers Retailers should be wary of price increases for items that limit the spread or effect of COVID-19, such as facemasks, sanitizers, disinfectants, cough medicine, and others. As scarcity continues to be a concern, the Department of Justice and state governments are responding by implementing and increasing enforcement of price gouging orders. President Trump recently issued Executive Order 13910 on March 23 authorizing the Secretary of Health and Human Services to designate certain healthcare and medical items as protected. Under the Order and the Defense Production Act, it is a crime to accumulate designated items—which include ventilators, respirators, PPE such as face masks and gloves, sterilization products, and disinfectant products—either over a person’s reasonable needs or to sell it over prevailing market prices. Attorney General Barr issued a March 24 Memorandum (described in the introduction) stating the Department’s intent to investigate and prosecute violators of the Order and creating the COVID-19 Hoarding and Price Gouging Task Force. Retail stores are at particular risk of enforcement actions related to these orders and should take care when adjusting prices for protected equipment. In New York City alone, the Department of Consumer and Worker Protection has received more than 7,200 complaints of price gouging related to COVID-19. New York City has filed three lawsuits against repeat offenders seeking over $100,000 in fines. With more states putting similar orders into place and the creation of the federal task force, greater enforcement of price gouging rules is inevitable. Procurement Fraud Although it received less attention than the new loan programs, the straight appropriations in the CARES Act presents increased fraud risk. Appropriated funds will be used to procure PPE, vaccines, COVID-19 tests and other medical supplies, cleaning services, and to fund the construction of new field hospitals and healthcare facilities. Enforcement against procurement fraud is already underway. As noted in the introduction, the Department of Justice announced on April 10 that it arrested and charged a Georgia man with wire fraud after fraudulently misrepresenting his ability to deliver 125 million facemasks and other personal protective equipment from domestic suppliers to the Department of Veterans Affairs. The orders would have totaled more than $750 million. As precedent, in the two years after Hurricane Katrina, the Department of Justice brought 800 prosecutions and conducted numerous qui tam and non-qui tam investigations. Businesses working to fulfill orders for personal protective equipment and other supplies are facing significant increased demand. Businesses must guard against producing substandard products, ignoring product failures and flaws, and passing through counterfeit product, all of which may lead to civil and criminal enforcement actions. These concerns apply equally to products in development. Businesses developing therapies and treatments for COVID-19 are under intense market pressure to bring their product to market. While there is insatiable demand for products that treat the virus, its symptoms, and/or prevent its spread, a business that prematurely brings a product to market that causes patient harm may face substantial exposure after the emergency passes. Whether businesses are new to the government procurement process or serve only government customers, the desire to move quickly cannot ignore compliance risk. Businesses must certify compliance with applicable regulations in exchange for payment from the government. Businesses must still pay attention to the details while working fast to satisfy government needs and being paid for that work. What Can My Organization Do Now? Understand the key legal remedies that will drive future risk—statutes like the False Claims Act. Pay attention to the details of government loan and procurement programs. Know what is required and comply. The implementing rules are a moving target and are being created “on the fly”—there is no substitute for understanding the details to minimize enforcement risk. Maintain internal controls and due-diligence procedures—through the good times and the hard times. Internal investigations remain—even in this environment—the key tool to identify and mitigate risks. While internal investigation activity may be slowed by the pandemic and its economic effects, curtailing investigations creates risk that the organization lacks visibility into misconduct or allegations of misconduct. Take internal complaints seriously. A cottage industry of qui tam relators is coming; the False Claims Act bar is recruiting whistleblowers now. You can mitigate that risk when internal whistleblowers feel “heard” and have their complaints addressed promptly and effectively. Understand the value of a timely, well-packaged voluntary disclosure to law enforcement or to the applicable agency. Busy agents and prosecutors may be receptive to “fully potted” disclosures and offer maximum cooperation credit in return.
April 14, 2020

