Qui Tam / Whistleblower

Qui Tam cases are a special class of lawsuits filed on behalf of the government by private citizens for false claims or fraud. The private citizen or whistle blower usually finds out about the fraudulent practices before the government. The whistleblower is entitled to bring a case on his or her behalf and the government’s behalf due to the fraud committed by another individual or a company. False claims generally include not delivering goods that were sold, overcharging for goods or services, making false statements about the quality of a product, improperly testing a product or any other scheme that is designed to defraud the government.

The person who files a Qui Tam lawsuit is known as a relator must comply with the requirements listed under the False Claims Act. If the suit is successful, the relator may generally recover between 15-30% of the government’s total recovery along with civil penalties. Qui Tam verdicts and settlements can reach into the hundreds of millions of dollars, so a relator’s percentage of the award can be substantial.

There are a number of healthcare industry related Qui Tam claims such as:

• Hospital and Medicare Fraud
• Prescription Drug Fraud
• Government Contract Fraud
• Environmental Programs Fraud
• Customs Fraud
• Research Programs Fraud
• Public Works Project Fraud
• Federal Government Construction Fraud
• Loan Guarentees Fraud
• Agricultural Subsidies Fraud
• Defense Contract Fraud
• Municipal Bond Market Fraud

If you have knowledge about a healthcare fraud being perpetrated on the United States government, it is important to contact a Qui Tam lawyer right away.

Florida Whistleblower Attorneys

The attorneys of Levine & Glassman are fully-versed in personal injury law and can help you navigate a Qui Tam lawsuit. There are several steps and procedures that you need to follow in order for the government to take your Qui Tam lawsuit. You need an experienced Qui Tam lawyer to put together the best case for you so that the government will accept your claim and prosecute the case.

Qui Tam Information Center

• Overview of False Claims Act
• Examples of Healthcare Related Qui Tam Cases
• Process of Filing a Qui Tam Claim
• How a Qui Tam Lawyer can Help

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Overview of False Claims Act

The False Claims Act 31 (U.S.C. §3729, et.seq.) was designed to encourage citizens with knowledge of fraud against the government to come forward by authorizing them to file a civil suit in the name of the government, and by rewarding the citizens with a percentage of the recovery.

Today’s federal False Claims Act provides for treble damages and penalties of $11,000 per violation for virtually any kind of fraud on federally funded programs. The qui tam provisions of the statute also allow the whistleblower also legally known as the relator, to receive up to 30% of the recovery.

The principal activities that constitute violations under the False Claims Act are:

• Knowingly presenting a false or fraudulent claim for payment to the federal government,
• Knowingly using a false record or statement to get a claim paid by the federal government,
• Conspiring with others to get a false or fraudulent claim paid by the federal government,
• Knowingly using a false record to statement to conceal, avoid, or decrease an obligation to pay money or transmit property to the Federal Government.

There are several ways that healthcare entities attempt to defraud the government. Listed below are some of the common ways healthcare agencies misappropriate government funds:

• Mischarging – examples of mischarging include a government contractor who charges the government for work that he or she did not actually perform. Another example of mischarging is when a doctor’s office bills Medicare for a procedure that costs more money, but they actually performed a procedure that is billed at a lower rate.
• False Negotiation / Defective Pricing – This misappropriation mostly occurs with government contracts where a contractor inflates the price or overstates the cost of materials or labor.
• False Documentation for Entitlement of Benefits – Examples of this fraud include applications for government benefits such as Medicare, Medicaid and food stamps.
• Product and Service Substitution – Example of this type of fraud is a pharmaceutical company certifying that their drugs and products meet FDA standards, but the products are in fact inferior.

It is important to contact a Qui Tam lawyer in order to determine if you have a strong case. Most times, the government can take over the prosecution of the case, but it is possible for you to file the Qui Tam case without the government’s involvement. Contact the attorneys at Levine and Glassman if you think you have a possible healthcare related Qui Tam claim.

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Examples of Healthcare Related Qui Tam Cases

Remember the False Claims Act covers fraud involving any federally funded program or contract with the exception of tax fraud. Some of the more common healthcare related Qui Tam cases include:

• False claims to Medicare or Medicaid for medical services rendered.
• Falsification by a contractor of test results or other information regarding the quality or cost of products and services sold to the government.
• Inaccurate diagnosis codes reported from a hospital to obtain Medicare or Medicaid payments.
• Kickbacks to physicians to induce them to prescribe certain medical devices or prescription medications.
• Inappropriate use of Food Stamps.
• A government grant recipient charging the government for costs not related to the grant.

Usually the whistleblower is a person working in the company. In the case of Medicare and Medicaid fraud, the whistleblower is usually a person that works in the office and has first-hand knowledge that the billing codes are incorrect. The False Claims Act provides protection against retaliation for individuals that come forward with Qui Tam cases.

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Process of Filing a Qui Tam Claim

There is a detailed process for filing a Qui Tam claim. It is highly advisable to seek out a Florida Qui Tam lawyer if you think you have information for a Qui Tam claim.

• Preparing the Disclosure Statement

The disclosure statement is the most essential part of the Qui Tam claim because the statement starts the entire case. According to the False Claims Act, a relator must provide the government with “a written disclosure of substantially all material evidence and information” that is in the relator’s possession. The purpose of the disclosure statement is to give the government as much information as possible about the fraud so that the government can decide whether or not they want to take over the lawsuit or allow the individual to proceed alone.

It is vital to hire a Qui Tam lawyer to assist you with the disclosure statement. The federal government is inundated with Qui Tam claims and it is impossible to prosecute all of the claims. Usually there is a great deal of expense to bring a Qui Tam action, so if you do not have government involvement, a great deal of the cost will fall on your shoulders. A Qui Tam lawyer can complete a good deal of the investigation and lay out legal strategy and analysis so that the government will be more inclined to take on the case.

• Filing the Complaint

Once a relator files a complaint, it will be kept under seal for at least 60 days while the Department of Justice investigates the claim and reviews the supporting evidence and materials. It can take the government up to two years before the investigation is completed. During the course of the investigation, the DOJ can formally join the lawsuit, decline to join the lawsuit, move to dismiss the action or attempt to settle the lawsuit.

• Government Intervention

If the government does join the lawsuit, then the government is primarily responsible for prosecuting the case. The relator can continue to participate in the case, but the government may reduce the relator’s role if it finds the relator’s participation would be repetitious or irrelevant to the government’s prosecution.

It is advantageous for the relator to take an active part in the government investigation. Under the False Claims Act, a relator receives 15% of the settlement for just filing the case. However, the relator can receive more compensation if they cooperate with the government and help the government build a strong case.

• Government Declines Intervention

You can still continue the case without government involvement. The government will continue to monitor the progress of the case and it is possible for the government to enter the case if it has “good cause” to intervene. If the government is not going to take the case, you will receive a letter declining involvement and outlining your duties if you decide to continue on with the case. The seal will be lifted and you will have 120 days to serve the defendant with notice of the lawsuit.

• What you have to Prove

You must prove the following 3 elements to have a violation of the False Claims Act:

• A claim must be presented to the government by the defendant, or the defendant must cause a third party to submit a claim.
• The claim must be made knowingly.
• The claim must be false or fraudulent.

It may seem like a simple enough task to demonstrate a company submitted a false claim to the government. However, it is very difficult to prove false claims when multi-million dollar companies are accused of submitting millions of dollars in false claims. You need to have a lot of documentation to conclusively show that the company knowingly submitted claims with the full intent of defrauding the government. These companies usually have a team of lawyers to defend them, and you may only have one lawyer if the government declines participation in the case.

It is vital to talk with a Qui Tam lawyer about the strength of your case and whether you have the time and resources to mount the Qui Tam case alone. If it is a really good Qui Tam case, it is possible for the attorney to work on a contingency fee. You must retain a Qui Tam attorney as soon as possible and lay out all of the relevant facts in order to see if you have a viable Qui Tam case.

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How a Qui Tam Lawyer can Help

The law related to whistleblowers and the False Claims Act is detailed and complicated. You do have some protection as a whistleblower, but how much protection is still being litigated in the court system. It is important to find out your rights and the risks involved before filing a Qui Tam action.

Right now, if you are a federal employee, you cannot be discharged, demoted, harassed, or discriminated against due to filing a Qui Tam claim. If you are subject to any other things in the previous sentence, you are entitled to compensation, reinstatement of your job, attorneys’ fees and reimbursement for any special damages.

If you are not a federal employee, you may need to look to Florida state law for whistleblower protections. Your attorney will be able to advise you as to what extent you or your job is protected under the law. If you are not protected under the law under some circumstances, the attorney can advise you about the risks and options in continuing with a Qui Tam case.

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Resources

Office of the Florida Attorney General – The Florida Attorney General Office is responsible for prosecuting Qui Tam claims and enforcing the state’s antitrust laws.

False Claims Act – This link goes to the Federal False Claims Act which enables individuals to file Qui Tam claims.

Levine & Glassman, P.A. – Florida Qui Tam Lawyers

The attorneys at Levine & Glassman have extensive experience at evaluating and pursuing medical malpractice and fraud claims in Fort Lauderdale and the surrounding areas of Broward, Miami-Dade, and Palm Beach counties. Contact our firm at (954) 332-6100 or using out online contact form and one of our attorneys will evaluate your potential Qui Tam case, explain the process of filing such a claim, and answer any other questions you may have. Once you have all of the information about filing a Qui Tam case, and you fully understand the benefits and consequences, we can make a decision together on whether to proceed with your case.