The 11th Circuit Preserves the FCA's Qui Tam Provisions

On September 1, 2026, the U.S. Court of Appeals for the Eleventh Circuit delivered a significant victory to False Claims Act (FCA) whistleblowers and the federal government. In United States ex rel. Zafirov v. Florida Medical Associates (No. 24-13581), the court reversed a district court decision that had declared the FCA’s qui tam provisions unconstitutional. For healthcare organizations, which bear the brunt of FCA enforcement, the ruling preserves the constitutionality of what essentially is the legal backbone of the FCA.

At the civil level, the FCA (31 U.S.C. §§ 3729–3733) dates back to 1863 (i.e., the Civil War) and remains the government’s primary tool against fraud involving federal funds. The law imposes treble damages (i.e., 3x damages) plus per-claim penalties on anyone who knowingly submits false claims to the federal government for payment.

The statute’s signature feature is its qui tam mechanism under 31 U.S.C. § 3730(b), which permits private citizens ("relators") to sue on behalf of the federal government. Under this framework, a relator files the complaint under seal, the federal government decides whether to intervene, and a successful relator collects a bounty of up to 30% of the financial recovery. This financial incentive makes qui tam suits the workhorse guiding most FCA recoveries, particularly under Medicare and Medicaid.

In 2025, health care accounted for over $5.7 billion of a record $6.8 billion in total FCA settlements and judgments. That same year saw a record 1,297 qui tam whistleblower suits filed and 401 government investigations opened. Since 1986, total FCA recoveries have surpassed $85 billion.

Dr. Clarissa Zafirov, a board-certified family medicine physician, sued her employer and its affiliates, alleging they submitted false diagnosis codes to inflate Medicare reimbursement. Because the federal government initially declined to intervene, Dr. Zafirov prosecuted the litigation herself.

In 2024, the defendants moved for judgment on the pleadings, arguing that the FCA’s qui tam provisions violate Article II of the U.S. Constitution, specifically the Appointments Clause, the Take Care Clause, and the Vesting Clause. Under the Appointments Clause, the President appoints ambassadors, public ministers, Supreme Court justices, and other officers of the United States, subject to Senate approval. Congress may vest the appointment of inferior officers in the President, courts, or department heads. The defendants argued that FCA relators exercise executive power to enforce federal law without being constitutionally appointed.

At the district court level, Judge Kathryn Kimball Mizelle of the Middle District of Florida agreed with the Appointments Clause challenge. Applying Lucia v. SEC, she concluded that relators wield significant federal authority and occupy a continuing "office of relator," making them officers who must be constitutionally appointed. Because Dr. Zafirov was not, the district court dismissed the case. The federal government then intervened to defend the FCA’s constitutionality.

The Eleventh Circuit vacated the dismissal and remanded the case. Writing for the panel, Judge Elizabeth Branch bypassed the question of whether relators exercise "significant authority." Instead, the decision rested entirely on the second Lucia requirement: whether a relator occupies a continuing position established by law.

The appellate court held they do not. Drawing on 19^th-century U.S. Supreme Court (SCOTUS) precedents like Germaine and Auffmordt, the panel found that a relator’s role is temporary, lasting only for the duration of a single case. A relator receives no ongoing salary, only a one-time contingent share of a recovery, and holds personal duties that cannot be transferred to a successor if they drop the case.

The court distinguished Morrison v. Olson, noting that an independent counsel’s duties transfer to a successor during litigation, whereas the FCA does not provide such a mechanism for substituting relators. The panel also rejected the concept of an "office of relator" entirely, noting that no such office exists in the text of the FCA.

With this ruling, the Eleventh Circuit joins the Fifth, Sixth, Ninth, and Tenth Circuits in upholding the constitutionality of the FCA’s qui tam provisions.

For healthcare and life sciences organizations, the ruling restores operational certainty. Relator-driven investigations, internal compliance programs, and the government’s practice of monitoring declined cases will continue as usual. Within the Eleventh Circuit, defendants cannot rely on an Appointments Clause defense to dismiss qui tam actions.

However, the constitutional challenge is not entirely dead. On remand, the district court must still address the defendants’ Take Care Clause and Vesting Clause arguments, which the appellate panel declined to analyze. Both arguments concern executive power: the Take Care Clause requires the President to ensure laws are faithfully executed, while the Vesting Clause places all executive power in the President. The defendants argue that allowing a private relator to litigate on behalf of the government encroaches on this exclusive authority. While the defense could still prevail on these grounds, it now faces a federal government with what amounts to appellate momentum.

For compliance-related planning, organizations must assume FCA qui tam liability remains active. Their focus should remain on accurate diagnosis coding, robust risk-adjustment practices, and solid documentation for Medicare Advantage submissions, the exact areas that frequently trigger relator suits in managed care.

The broader constitutional debate is not fully resolved. Justices Thomas, Kavanaugh, and Barrett have previously signaled, in United States ex rel. Polansky v. Executive Health Resources, Inc. (No. 21–1052) and elsewhere, an interest in evaluating whether the qui tam framework aligns with Article II.

Because the federal circuits are currently in agreement, there is no split to fast-track the issue. As a result, the Supreme Court may be slower to grant certiorari. Nevertheless, the defendants can seek en banc rehearing from the Eleventh Circuit or petition SCOTUS directly. Given the stated interest of several justices, the constitutionality of qui tam enforcement will likely reach SCOTUS eventually. For now, healthcare clients defending FCA matters must preserve their Article II arguments while continuing to manage compliance under the current statutory framework.

Disclaimer: This industry insight is for general information only, is not legal advice, and does not create an attorney-client relationship.