Check out attorney Knicole Emanual’s new blog post about new legislation making it easier for the government to prosecute Medicare fraud on smaller claims. It’s pretty well known that the Department of Justice (DOJ) focus on fraud cases in excess of many millions, so practitioners may feel that they are not likely to be investigated for relatively “small” amounts of potentially fraudulent claims. Ms. Emanuel’s recent post is a heads-up to everyone.
An important piece of legislation was included as part of the National Defense Authorization Act (NDAA) for Fiscal Year 2025, which increases the chances that smaller-dollar cases of fraud will be prosecuted. Previously, only claims involving fraud of up to $150,000 could be processed through an administrative process, bypassing the complexities (and cost) of litigation. However, the Administrative False Claims Act (AFCA) raises this threshold to $1 million, greatly expanding the scope of claims that can be reviewed and prosecuted without going through the traditional court system.
Quoting her article:
“This legislative shift is seen as a key development in tackling the vast number of smaller frauds that often evade the spotlight in comparison to high-profile corporate scandals or massive government contract abuses. By making it easier to address frauds that might otherwise be dismissed as too small to prosecute, the AFCA addresses a significant gap in the enforcement of the False Claims Act, which has traditionally focused on larger, more visible frauds.”
“The passage of the AFCA represents a major victory for whistleblower protections and anti-fraud enforcement in the U.S. It is a critical element of the National Whistleblower Center’s ‘Seven Major Campaigns of 2024,’ which aims to strengthen legal tools and protections for those who expose government fraud. The law is expected to enhance the ability to take swift action against a broad range of fraudulent schemes, ensuring that those who seek to defraud the government, no matter the size of their fraud, are held accountable.”
This legislation also makes it more likely that individuals who act as “whistleblowers” for causes under a million dollars could realize the associated monetary rewards. (Keep in mind that some whistleblowers are office staff who see questionable behaviors and report them.) You will want to read Ms. Emanuel’s article in its entirety.
