Fighting Federal False Claims Act Allegations: Key Defenses for Business Owners and Medical Professionals

The consequences can be devastating when federal authorities allege that a business owner or healthcare provider has violated the False Claims Act (FCA). Civil penalties, criminal charges, reputational harm, and even the loss of licensure are all on the line.

John Caudill Attorney at Law provides skilled, aggressive defense for clients in Bowling Green, Owensboro, and throughout Kentucky facing these serious allegations. Understanding your legal options is essential if you’re under investigation or have been formally charged.

What Is the False Claims Act?

The False Claims Act is a federal law that prohibits individuals and entities from knowingly submitting false or fraudulent claims for payment to the U.S. government.

Common examples include:

• Overbilling Medicare or Medicaid.
• Billing for services not rendered.
• Upcoding procedures to receive higher reimbursement.
• Submitting false certifications for government contracts.

The FCA allows government and private whistleblowers to bring claims. While these cases often begin as civil matters, they can quickly escalate to federal criminal investigations.

Who Is at Risk?

Healthcare providers, including doctors, nurses, clinics, and billing companies, are frequent targets of FCA investigations, especially in Medicare and Medicaid billing. However, business owners with federal contracts or those involved in federally funded programs can also face scrutiny for misrepresentation, false documentation, or failure to meet contract obligations.

Our law office has seen firsthand how honest professionals can become entangled in complex investigations due to clerical errors, confusing regulations, or bad organizational actors.

Key Legal Defenses to False Claims Allegations

Mounting an effective defense begins with understanding the government’s burden of proof. The FCA requires that the defendant knowingly submitted a false claim.

That opens the door for several viable defense strategies:

• Lack of Intent

A mistake or billing error doesn’t automatically equal fraud. The claim may be invalid without intent to deceive or defraud. We work to show that the issue resulted from human error, inadequate training, or ambiguous coding guidelines.

• Compliance with Regulations

Regulatory rules can be vague, and compliance interpretations may vary. Demonstrating that you or your business operated in good faith based on a reasonable understanding of the rules can undermine the government’s argument.

• No False Statement or Material Misrepresentation

In some cases, the alleged “false claim” may not be false at all or immaterial to the government’s payment decision. We review the facts and technical documentation to challenge the accusation’s legal merits.

• Whistleblower Credibility Issues

If a whistleblower brings a qui tam case, we scrutinize their motives, credibility, and any financial incentive they may have for initiating the claim.

Don’t Wait to Build Your Defense

False Claims Act cases move quickly, and federal prosecutors have powerful resources. You need a defense attorney who understands the complexity of federal law, knows how to challenge government investigations, and won’t back down in the face of aggressive prosecution.

Contact John Caudill in Warren County today by calling (270) 925-0447 if you’re a business owner or medical professional under investigation for False Claims Act violations. We’ll fight to protect your reputation, livelihood, and future.