False Claims Act

Contained below is information on both the federal and state false claims act (FCA).  The federal FCA has been in effect since 1863, however, dormant until it was revised in 1986 by Congress.   The original Oklahoma State FCA became effective November 1, 2004, however, it was recently updated.  The new revision became effective November 1, 2007 and directly addresses Medicaid payments.

Our office is available to present group or individual training sessions on the FCA to all employees upon request.

Federal False Claims Act

Summary:  The False Claims Act 31 U.S.C. sec. 3729-3733, protects the federal government against fraud and abuse.  Under the False Claims Act (FCA), anyone who knowingly submit, or causes another person or entity to submit, or knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approval of government funds are liable for three times the government's damages plus civil penalties of $5,500 to $11,000 per false claim.

The term "knowingly" means that a person:

  1. has actual knowledge of the information;
  2. acts in deliberate ignorance of the truth or falsity of the information; or
  3. acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.


The FCA contains qui tam, or whistleblower, provisions which allow anyone with evidence of fraud to sue on behalf of the government, in order to recover overpayments of federally funded health care programs.  The Department of Justice can investigate and decide whether to join the action.  If the government elects not to intervene, the qui tam relator may proceed with the action.  The whistleblower may be awarded a percentage of the recovered funds. 


For a further information on the FCA for OU/OUHSC, please click on False Claims Act
For further details, access Department of Justice resources on the False Claims Act, click on the link(s) below -

False Claims Act Title 31

False Claims Report

Oklahoma State False Claims Act

The Oklahoma State false claims act (FCA) was updated on May 8, 2007 to create provisions related to Medicaid reimbursement for professional services.  The updated FCA became effective November 1, 2007.  The revisions were due to the Deficit Reduction Act (DRA) of 2005.  The DRA has made Medicaid Fraud and Abuse compliance programs mandatory for many organizations.  The DRA mandates that any entity which receives at least $5 million in Medicaid payments per year must implement employee education programs and policies related to Medicaid fraud and abuse.   Under the state FCA, any person who:

  1. knowingly presents, or causes to be presented, to an officer or employee of the State of Oklahoma, a false or fraudulent claim for payment or approval;
  2. knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the state;
  3. conspires to defraud the state by getting a false or fraudulent claim allowed or paid;

The term "knowingly" means that a person:

  1. has actual knowledge of the information;
  2. acts in deliberate ignorance of the truth or falsity of the information; or
  3. acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required.

In the state FCA, civil penalties for false claims are similar to those addressed in the federal FCA.   The State FCA also has established statutes of limitations as to the length of time an individual may pursue false claims issues.   To access the entire statute, please click on State False Claims Act.

Please note the Oklahoma Health Care Authority (OHCA) has developed a web-based education on false claims.  To access their program, you will need to go to the Oklahoma Learning Management System by clicking on the following link - www.oklms.org and register as a new user.  For more details, please click on OHCA false claims program.