False Claims Act  ·  Case Evaluation

Case evaluation is everything. A weak case filed is worse than no case at all.

Not every troubling fact is a False Claims Act case. The first job is honest evaluation — not promising a lawsuit. Here is how that evaluation works, and what it takes to pass it.

Most troubling facts are not False Claims Act cases. That is not a reason not to call — it is a reason to know early.

The False Claims Act is a precise statute. It does not reach every instance of government contractor misconduct, every regulatory violation, or every situation where a company behaved badly and federal money was involved. A regulatory violation is not automatically an FCA violation. A contract dispute is not fraud. Shoddy work is not necessarily a false claim. The distinction matters — because filing a case that cannot survive legal scrutiny does not help the relator. It costs them years.

This practice is built around an evaluation methodology designed to answer that question honestly before a complaint is ever filed. Not every case that passes screening is filed. Not every situation that sounds like fraud meets the legal standard. The first job is accurate diagnosis — not promising a lawsuit.

That honesty is not a constraint on this practice. It is the foundation of it. A selective practice that declines cases forthrightly is more trustworthy — and ultimately more effective — than one that files everything and hopes the government carries the weight.

Read the full FCA practice overview →

Legal theory assessment
Does the conduct fit within what the FCA actually prohibits, and can a viable complaint theory be constructed?
Evidence inventory
What corroborating evidence exists, what might be obtainable through investigation, and what gaps could be fatal.
DOJ intervention projection
An honest assessment of whether the case is likely to attract government intervention — and what the path looks like without it.
Threshold bar analysis
First-to-file, public disclosure, and statute of limitations — reviewed before any other analysis proceeds, because they determine whether the rest matters.

Two questions determine whether a qui tam case is worth filing.

Every other factor — the size of the fraud, the type of government program, the relator's position — matters only after these two questions are answered honestly. The framework is simple. Applying it rigorously takes experience on both sides of it.

01

Is there a legally cognizable false claim theory?

Can we identify a specific misrepresentation — an express false statement, a false implied certification, or a fraudulent scheme — that caused the government to pay money it would not have paid if it had known the truth? This is not a question about whether something wrong happened. It is a question about whether what happened fits within what the False Claims Act actually prohibits.

The answer is not always obvious. Regulatory violations do not automatically create FCA liability. Breach of contract is not fraud. Understanding the line between them — and where courts have drawn it over the last decade — is the first filter every case must pass.

02

Can we prove it in a way that matters to DOJ?

The government receives thousands of qui tam complaints. It intervenes in a fraction of them. What drives that decision is not whether the relator believes fraud occurred — it is whether the evidence is strong enough to make investigation worth federal resources, and whether the case is significant enough to justify DOJ's attention.

This is where having spent time on the other side matters most. The evaluation is not just legal analysis — it is an honest projection of how DOJ will look at what you have. That perspective shapes everything from the disclosure statement to the case theory to the decision whether to file at all.

Evaluation from three vantage points no single attorney usually has.

Most FCA attorneys have spent their careers exclusively as plaintiff's lawyers. Rob has also evaluated these exact case types as a federal prosecutor and litigated them from the defense side. Each perspective exposes different risks — and different strengths — that a single vantage point misses.

As a Plaintiff's Lawyer

Having represented plaintiffs in fraud and employment matters for years, Rob has watched cases fall apart at deposition, at summary judgment, and in front of juries — often because the theory was compelling but the evidence wasn't. That experience gives his evaluations a realistic anchor: not whether fraud was real, but whether it can be proven through the demanding standards of federal court.

Evaluating a case from this vantage point means looking for the strongest possible theory — and being honest when the strongest available theory still isn't strong enough to recommend filing.

As a Federal Prosecutor

As an AUSA in the District of Oregon, Rob reviewed FCA disclosure statements and evaluated whether DOJ should commit investigative resources to specific matters. He knows what federal investigators find credible, what they find thin, and what evidence makes them move faster. He also knows what language in a disclosure statement raises skepticism rather than interest.

Structuring a qui tam filing to attract DOJ attention is a skill most relators' attorneys learn by trial and error. Rob learned it from the inside — evaluating those very filings from the other side of the table.

As a Defense Litigator

Rob has litigated on the defense side of employment and civil matters. He knows the arguments that get cases dismissed, the discovery strategies that exhaust relators, and the legal theories defendants use to challenge FCA claims at the pleading stage and beyond. That knowledge does not make him less aggressive. It makes him harder to surprise.

Every case evaluated here is stress-tested against the strongest arguments the other side is likely to raise. Cases that cannot survive that test are identified before they are filed — not after.

More on Rob's background: Three vantage points, one practice →

What federal investigators actually look for in a qui tam disclosure.

DOJ evaluates disclosure statements through a practical lens: Is this credible? Is this significant? Is this worth our time and resources? The cases that receive serious attention share predictable characteristics — and cases that lack them rarely attract intervention.

Documents That Anchor the Theory

Emails, billing records, internal reports, lab certifications, contract deliverables, or cost reports that show the gap between what was represented to the government and what was actually done. The relator does not need everything — but the narrative needs to be anchored in something the government can independently verify.

A Specific, Identifiable Pattern

One false claim is a data point. A systematic pattern across billing cycles, facilities, contract periods, or deliverables is a case. DOJ looks for evidence of knowing, repeated conduct — not isolated incidents that a defendant can credibly attribute to error or misunderstanding.

A Clear Federal Money Nexus

The government must have paid, or been at risk of paying, based on the false claim. Medicare and Medicaid billing, defense and civilian federal contracts, and federal grants all create clear nexuses. The connection between the misrepresentation and the federal payment needs to be direct — not attenuated through layers of subcontracts or state intermediaries.

Significance That Justifies Federal Resources

DOJ prioritizes cases where the potential recovery justifies investigation costs. There is no rigid dollar floor, but cases where the fraud pattern can be extrapolated across the fraud period — healthcare billing across thousands of claims, defense contractor overcharges across a multi-year contract — command the most serious attention.

A Well-Positioned, Credible Relator

The relator's firsthand access matters. Someone who worked in billing, compliance, contract management, or direct patient care has direct knowledge of what happened. A relator who learned about fraud secondhand or through inference is harder for DOJ to build a case around. Credibility and positioning are part of every evaluation.

No First-to-File or Public Disclosure Bar

If another relator has already filed covering the same conduct, or if the fraud has been publicly disclosed through audits, litigation, or press coverage, the case may be barred before any merits analysis begins. These are threshold issues — they are evaluated first, because they determine whether everything else matters.

If the case doesn't hold up, we tell you. That's the job.

"Filing a weak qui tam case does not help the relator. It costs them years, exposes them to fee-shifting in some circumstances, and can foreclose better options. Honest declines are how a serious practice earns trust."

Most attorneys evaluate cases based on whether a theory sounds plausible. Rob evaluates them based on whether they can survive the disclosure statement review, withstand DOJ scrutiny, and hold up through the demands of federal litigation. That standard produces more declinations — and better outcomes for the cases that do move forward.

Every relator deserves to know — before they file — what the realistic path looks like. What DOJ is likely to do with the disclosure. What the defense will argue. How long it will take. What the case looks like if the government doesn't intervene. That assessment is not incidental to evaluation. It is the evaluation.

Former AUSA · District of Oregon FCA Intervention Experience ~400 Settlements Negotiated National FCA Practice

What people ask before they let someone look at their case.

How do you decide whether a False Claims Act case is worth filing?
Every evaluation begins with two questions: Is there a legally cognizable false claim theory — a specific misrepresentation made to obtain federal money that fits within what the statute prohibits? And can we prove it in a way that matters to DOJ — is there corroborating evidence sufficient to compel federal investigation, and is the fraud significant enough to justify federal resources? If both answers are yes, filing may be appropriate. If either answer is no, honest evaluation means saying so before a complaint is drafted.
What is the most common reason a qui tam case fails after it has been filed?
The most common failure points are materiality and insufficient evidence. After Universal Health Services v. Escobar (2016), the FCA requires that the misrepresentation be material — meaning it actually influenced whether the government paid. Courts have dismissed cases where the government continued paying claims even after learning of the alleged violation, which undercuts the materiality argument. The second failure point is evidence: relators who cannot support their theory with documents or corroborating data face demanding pleading standards under Rule 9(b). Both issues can be identified and addressed — or accepted as disqualifying — before a complaint is ever filed.
How much evidence do I need before you can evaluate my case?
A preliminary evaluation can begin with what you know. You do not need to arrive with a complete file. What matters at the screening stage is whether there is a plausible federal money nexus, a theory of misrepresentation that fits the statute, and some basis — however preliminary — for believing the conduct occurred. The evaluation will identify what corroborating evidence exists or might be obtainable through investigation, which shapes both the strength of the case and how the complaint is structured. Evidence gaps are not automatically disqualifying; they are part of what the evaluation is designed to identify.
What happens if DOJ declines to intervene in my qui tam case?
If DOJ declines intervention, the relator has the right to proceed independently — but these cases are significantly harder and more expensive. The relator bears litigation costs without the government's investigative resources and institutional credibility. Some declined cases have produced recoveries, but most do not. Honest case evaluation includes a candid assessment of whether a case is strong enough to proceed without government intervention, and whether the economics of doing so make sense for the relator. That assessment happens before filing — not after DOJ has already weighed in.
Does it matter that I've already reported the fraud internally or to a government agency?
Internal reporting generally does not bar a qui tam case. Reporting to a regulatory agency requires more careful analysis — if the matter was subsequently disclosed publicly through press coverage, an audit report, or prior litigation, the public disclosure bar may apply. Whether internal or regulatory reporting triggers any bar depends on exactly what was disclosed, to whom, and whether it became public. This is one of the first issues evaluated in any case screening, because it determines whether the rest of the analysis matters.

Find out honestly whether your situation is a case.

The screening is free, confidential, and available now. A former Assistant U.S. Attorney reviews every matter that passes screening personally.

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