Qui Tam Lives To Fight Another Day: What The Eleventh Circuit’s Zafirov Decision Means For The False Claims Act

The False Claims Act’s qui tam provisions are among the federal government’s most important tools for identifying and pursuing alleged fraud involving Medicare, Medicaid, federal health care programs and other government funds. The statute permits a private individual, known as a relator, to bring a False Claims Act action “for the person and for the United States Government” in the name of the government. 31 U.S.C. § 3730(b)(1). If the action succeeds, the relator may receive a share of the recovery. Id. § 3730(d). For health care providers, pharmacies, manufacturers, contractors and others that submit claims to or receive funds from the federal government, qui tam litigation has long been a significant source of False Claims Act exposure.

That enforcement structure faced a serious constitutional challenge after a federal district court in Florida held in 2024 that the False Claims Act’s qui tam provisions violate the Appointments Clause of Article II. United States ex rel. Zafirov v. Florida Medical Associates, LLC, 751 F. Supp. 3d 1293 (M.D. Fla. 2024). On September 1, 2026, the U.S. Court of Appeals for the Eleventh Circuit reversed. The appellate court held that a False Claims Act relator is not an “Officer of the United States” because the relator does not occupy a continuing position established by law. United States ex rel. Zafirov v. Florida Medical Associates, LLC, No. 24-13581 (11th Cir. Sept. 1, 2026). The decision preserves the existing qui tam framework, but it does not end the broader constitutional fight over private enforcement of the False Claims Act.

How the Zafirov False Claims Act Challenge Reached the Eleventh Circuit

Dr. Clarissa Zafirov, a family medicine physician, filed a qui tam action in 2019 against Florida Medical Associates, doing business as VIPcare and several related entities. She alleged that the defendants knowingly submitted false diagnosis codes to receive more money than they were entitled to receive from Medicare. The United States initially declined to intervene in the underlying False Claims Act case but later intervened for the limited purpose of defending the constitutionality of the statute’s qui tam provisions after the defendants raised constitutional challenges.

The defendants argued that the qui tam provisions violated three separate components of Article II: the Appointments Clause, the Take Care Clause and the Vesting Clause. Their Appointments Clause theory was straightforward but potentially far reaching. Under the Supreme Court’s framework, an individual is an officer if the individual exercises significant authority under federal law and occupies a continuing position established by law. See Lucia v. SEC, 585 U.S. 237, 245 (2018). Because a private relator is not appointed through the process required by Article II, the defendants argued that a relator exercising federal enforcement authority cannot constitutionally prosecute an action in the name of the United States.

Judge Kathryn Kimball Mizelle of the Middle District of Florida agreed with the Appointments Clause argument. The district court concluded that relators exercise significant authority by prosecuting claims belonging to the United States and that the False Claims Act effectively creates an “office of relator.” Zafirov, 751 F. Supp. 3d at 1307–17. Because Zafirov had not been appointed in accordance with Article II, the district court held that the qui tam provisions violated the Appointments Clause and dismissed the action. Id. at 1322–23. Having resolved the case under the Appointments Clause, the district court did not reach the defendants’ separate Take Care Clause and Vesting Clause arguments. Id. at 1304.

The Eleventh Circuit Rejects the Appointments Clause Challenge

The Eleventh Circuit vacated the dismissal and rejected the district court’s conclusion that a False Claims Act relator holds an office within the meaning of Article II. The appellate court focused on whether a relator occupies a “continuing position established by law,” one of the requirements identified by the Supreme Court for determining whether an individual qualifies as an Officer of the United States.

Rather than accepting the district court’s concept of an ongoing “office of relator,” the Eleventh Circuit examined the actual characteristics of an individual relator’s role. Drawing from Supreme Court precedent, the court considered the relator’s tenure, duration, compensation and duties. It concluded that relators have temporary tenure and duration, no continuing emolument and personal duties tied to the particular action they bring. Zafirov, No. 24-13581, slip op. at 9–17.

That conclusion was sufficient to resolve the Appointments Clause issue. Because relators do not occupy a continuing position, the Eleventh Circuit held that they are not Officers of the United States subject to the Appointments Clause. The court therefore did not reach the separate questions of whether relators exercise executive power or “significant authority.” Id. at 8, 17.

The Eleventh Circuit also expressly joined the other federal courts of appeals that have addressed the issue and rejected Appointments Clause challenges to False Claims Act relators. See Riley v. St. Luke’s Episcopal Hospital, 252 F.3d 749, 758 (5th Cir. 2001) (en banc); United States ex rel. Taxpayers Against Fraud v. General Electric Co., 41 F.3d 1032, 1041 (6th Cir. 1994); United States ex rel. Kelly v. Boeing Co., 9 F.3d 743, 757–59 (9th Cir. 1993); United States ex rel. Stone v. Rockwell International Corp., 282 F.3d 787, 804–05 (10th Cir. 2002). Zafirov, No. 24-13581, slip op. at 3 n.2. Thus, rather than creating a circuit split, the Eleventh Circuit aligned itself with the existing appellate authority rejecting this particular constitutional challenge.

What the Eleventh Circuit Did Not Decide

The most important limitation of Zafirov is what the Eleventh Circuit left unresolved. The court addressed only the Appointments Clause. It expressly remanded the case so that the district court could consider the defendants’ remaining arguments under the Take Care Clause and the Vesting Clause in the first instance. Zafirov, No. 24-13581, slip op. at 18.

Those theories present a different constitutional question. Even if a relator is not an Officer of the United States who must be appointed under Article II, the defendants contend that permitting a private party to exercise federal enforcement authority interferes with executive power vested in the President and the President’s obligation to take care that the laws are faithfully executed.

That distinction matters for False Claims Act defendants. Zafirov rejects the Appointments Clause theory in the Eleventh Circuit, absent further appellate proceedings, but it does not eliminate Article II challenges to qui tam enforcement altogether. The case now returns to the district court, where the Take Care Clause and Vesting Clause arguments remain to be addressed.

Practical Impact for Health Care Providers, Pharmacies and Government Contractors

For health care providers and other entities facing False Claims Act risk, the immediate consequence is that the traditional qui tam enforcement model remains intact. Private relators may continue filing actions under 31 U.S.C. § 3730(b). When a relator files a qui tam complaint, the complaint remains under seal for at least 60 days while the government determines whether to intervene. Id. § 3730(b)(2). The government may intervene and conduct the action or decline to intervene, in which case the relator has the right to conduct the action. Id. § 3730(b)(4).

The decision therefore does not reduce the need for organizations that bill Medicare, Medicaid or other federal programs to maintain effective compliance systems, investigate credible internal complaints and respond carefully to allegations that could develop into a whistleblower action.

The decision is particularly relevant in health care because False Claims Act cases frequently arise from billing, coding, medical necessity, kickback, pharmacy, drug pricing, enrollment and reimbursement disputes. The statute imposes liability on a person who, among other things, “knowingly presents or causes to be presented, a false or fraudulent claim for payment or approval” or “knowingly makes, uses or causes to be made or used, a false record or statement material to a false or fraudulent claim.” 31 U.S.C. § 3729(a)(1)(A)–(B).

The financial exposure can be significant. The False Claims Act provides for three times the amount of damages sustained by the government, in addition to an inflation-adjusted civil penalty for each violation, subject to the statutory framework. Id. § 3729(a)(1). The procedural and constitutional rules governing qui tam litigation, therefore, matter well beyond the threshold question of whether a relator may bring the case.

The Constitutional Fight Over False Claims Act Qui Tam Litigation Is Not Over

Zafirov is an important win for the existing False Claims Act enforcement structure, but it should not be read as a definitive resolution of every constitutional challenge to qui tam litigation. The Eleventh Circuit answered a specific Appointments Clause question and answered it narrowly: relators are not Officers of the United States because they do not occupy a continuing position established by law.

The court left the Take Care Clause and Vesting Clause arguments unresolved and expressly returned those issues to the district court. The constitutional debate over the role of private relators in federal enforcement, therefore, remains alive.

For now, the practical landscape remains largely unchanged. Qui tam relators remain a central part of False Claims Act enforcement, and defendants should expect relator-driven cases to continue. At the same time, Zafirov ensures that the constitutional debate will continue on remand and potentially in future appellate litigation. Health care providers, pharmacies, manufacturers and government contractors should therefore view the decision as preserving the status quo, not closing the door on further challenges to the scope and structure of private False Claims Act enforcement.

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