Medicaid Fraud Claim & False Claims Act Structural Analyzer

Total Alleged Base Loss

Direct sum of unadjusted Medicaid claims submitted.

Statutory Treble Damages (3x)

Mandatory 31 U.S.C. § 3729(a)(1) treble multiplication.

Min Exposure (Treble + Min Pen.)

Includes statutory minimum penalties per claim ($13,508).

Relator Min Recovery

Case Dynamics & Statutory Parameters

Qui Tam Relator Recovery Share (%):

15% (Gov Intervened Min) 25-30% (Non-Intervened)

Min Penalty Per Claim ($):

Max Penalty Per Claim ($):

Medicaid Billing Claims Matrix

Adjust claim parameters, scienter, materiality, and Rule 9(b) pleading specificity.

Claim ID / Period	Alleged Statutory Violation	Submitted Count	Avg Reimbursement	Scienter Level	Materiality	Rule 9(b) Score	Actions

Canonical Proof Surface Jurisdiction: U.S. District Court / Fifth Circuit Appeals

State Medicaid Provider Termination & False Claims Act Materiality under Escobar Standard

Rule 9(b) Sufficiency Verdict

Sufficient Particularity Established for Trial / Summary Judgment

Total Min Statutory Penalties $0 Based on minimum statutory penalty bound per claim

Total Max Statutory Penalties $0 Based on maximum statutory penalty bound per claim

Total Alleged Base Damages $0 Unadjusted actual Medicaid reimbursement payout

Evidentiary & Materiality Assessment

Under universal FCA standards (Universal Health Services v. United States ex rel. Escobar), allegations must satisfy rigorous materiality and Rule 9(b) pleading specificity thresholds (who, what, when, where, and how). Based on current claims, the weighted particularity score demonstrates sufficient detail to survive a Motion to Dismiss.