Frank Mazzagatti Discusses False Claims Act at IAHA Health Law Symposium

Frank A. Mazzagatti, a prominent legal expert in healthcare law, delivered a comprehensive presentation on the False Claims Act (FCA) at this year’s Illinois Association of Healthcare Attorneys (IAHA) Annual Health Law Symposium. The session provided healthcare professionals and legal practitioners with critical insights into one of the federal government’s most powerful tools for combating fraud in the healthcare sector.

During his address, Mazzagatti outlined the fundamental aspects of the False Claims Act, which has become increasingly significant in healthcare enforcement actions. The Act, originally enacted during the Civil War to combat defense contractor fraud, has evolved into a primary mechanism for the government to pursue allegations of healthcare fraud and abuse, particularly in Medicare and Medicaid programs.

“The FCA continues to be the Department of Justice’s most effective weapon against healthcare fraud,” Mazzagatti explained to the audience of healthcare attorneys and executives. “Understanding its nuances is essential for providers operating in today’s complex regulatory environment.”

The presentation highlighted recent enforcement trends, noting that FCA cases in healthcare have resulted in billions of dollars in settlements and judgments over the past decade. In fiscal year 2022 alone, the Department of Justice recovered over $2.2 billion from FCA cases, with healthcare fraud accounting for more than 80% of those recoveries.

Mazzagatti, a partner at Hinshaw & Culbertson LLP, brings substantial expertise in healthcare compliance and fraud matters. His practice focuses on representing healthcare providers in regulatory investigations, compliance issues, and litigation, making him well-positioned to address the complexities of FCA enforcement.

The symposium session explored several key aspects of the FCA, including qui tam provisions that allow whistleblowers to file lawsuits on behalf of the government and potentially receive a portion of any recovered funds. These provisions have dramatically increased the number of FCA cases in recent years, with insiders at healthcare organizations frequently initiating investigations.

Healthcare executives in attendance expressed particular interest in the discussion of “materiality” standards following the Supreme Court’s landmark Escobar decision, which refined how courts determine whether alleged violations are substantial enough to trigger FCA liability. Mazzagatti explained that this evolving standard has created both challenges and opportunities for defendants in FCA litigation.

The presentation also addressed the substantial penalties associated with FCA violations. Current penalties include treble damages (three times the amount of the government’s losses) plus additional penalties ranging from $12,537 to $25,076 per false claim. These escalating penalties have made FCA compliance a top priority for healthcare organizations of all sizes.

Industry analysts note that FCA enforcement has expanded beyond traditional billing fraud to include allegations related to quality of care, medical necessity, and violations of the Anti-Kickback Statute and Stark Law. This broader application of the FCA has increased legal risks for providers across the healthcare spectrum.

“What makes the FCA particularly challenging is that violations don’t require specific intent to defraud,” Mazzagatti told attendees. “Knowledge standards under the Act can include ‘deliberate ignorance’ or ‘reckless disregard’ of the truth, creating significant liability risks even in the absence of deliberate misconduct.”

The IAHA Annual Health Law Symposium, a premier gathering for healthcare attorneys in Illinois, provides a forum for discussion of emerging legal challenges in the healthcare industry. This year’s event featured sessions on various aspects of healthcare law, including privacy regulations, telehealth compliance, and pandemic-related policy changes.

As healthcare fraud enforcement continues to intensify under the current administration, legal experts anticipate that FCA cases will remain a central focus for federal prosecutors. Healthcare providers increasingly invest in robust compliance programs and proactive risk assessments to mitigate potential FCA exposure.

Mazzagatti concluded his presentation by emphasizing the importance of developing comprehensive compliance strategies and conducting thorough internal investigations when potential issues arise. “The best defense against FCA liability begins with a culture of compliance and transparency,” he advised the audience.

The symposium continues to serve as an essential educational resource for healthcare attorneys navigating the increasingly complex regulatory landscape of the American healthcare system.