Both the FCA and California Insurance Fraud Prevention Act (“CIFPA”) have limitations on filing certain actions, including: (a) the first to file bar, 31 U.S.C. § 3730(b)(5) and Cal. Ins. Code §1871.7(e)(5); and (b) the public disclosure bar, 31 U.S.C. § 3730(e)(4)(A)-(B); Cal. Ins. Code §1871.7(h)(2)(A)-(B).

Under the public disclosure bar, relators/whistleblowers are barred from pursuing claims if they allege substantially similar allegations or transactions were publicly disclosed, unless the relator is the “original source.” 31 U.S.C. § 3730(e)(4)(A)-(B); Cal. Ins. Code §1871.7(h)(2)(A)-(B). However, what constitutes an “original source” varies slightly between the statutes.

Under the FCA, an “original source” is an individual who either: (1) voluntarily disclosed the information underlying their allegations to the government prior to filing; or (2) has independent knowledge that materially adds to the publicly disclosed information and voluntarily provided that information to the government prior to the filing. 31 U.S.C. § 3730(e)(4)(B).

Under the CIFPA, an “original source” is an individual with direct and independent knowledge of the publicly disclosed information underlying the allegations and voluntarily provided such information to the district attorney or Insurance Commissioner before filing the action. Cal. Ins. Code §1871.7(h)(2)(B) (emphasis added).

CPM is currently prosecuting and investigating several healthcare fraud schemes under the FCA and CIFPA on behalf of whistleblowers. If you are aware of any information about such practices, please contact us.