False Claims Act, “Qui Tam” Litigation, and Whistleblower Claims

Sometimes a situation arises in which a person working at a company realizes that the company is engaging in wrongful conduct that overbills the government.

For example, there have been cases in which a hospital employee learned that the way the hospital was billing the United States Government Medicare/Medicaid system was wrongful because the costs and charges were falsely inflated.

In those kinds of cases, the employee “whistleblower” may have the right under the law to bring a special legal complaint that allows the government to investigate and allows the whistleblower the right to recover damages as well.

The False Claims Act:

One law that protects whistleblowers in these circumstances is the Federal False Claims Act,sometimes known as the “Qui Tam” statute or the “FCA.”

Under that law, a whistleblower may have a claim when he knows that a company or employer is knowingly presenting false claims to the United States Government for payment.

The FCA provides the whistleblower and the government with a claim where the evidence shows that a company presented such a false and fraudulent claim.

Also, under the FCA, an employee who is discharged or harassed because of his involvement as a whistleblower, may have a claim for damages. This subsection was added to the FCA statute to provide a remedy for whistleblowers who get harassed or fired as a result of their whistleblowing activities.

The FCA requires certain confidentiality measures be taken. If the whistleblower has gone public with the information he has about the fraud, or if the fraud is widely known about in the media, then there may be no FCA claim. This is because the FCA is meant to protect the government’s ability to confidentially examine the claim.

The federal statute is found at 31 U.S.C. Section 3729. This law allows a private person to sue a company that is knowingly submitting false bills to the federal government.

Unlike other lawsuits, a complaint under the False Claims Act must be sent to the government but must NOT be sent to the defendant until ordered by the court. It must be filed with the court under seal. It must be supported by detailed facts.

The parties must maintain secrecy and cannot discuss the case with other people or with the media. The government must be allowed a chance to investigate the allegations in secret.

After the legal complaint is filed under seal, and the detailed factual memo and supporting documents are served on the government, then the government can decide whether to become involved in the case or not. To read more about a current whistleblower claim our firm is involved in, click  to view the Fry vs Guidant case.

Qui Tam and Whistleblower Claims

As noted, “whistleblower” claims are legal claims on behalf of individuals and employees who know of fraudulent and illegal practices that employers and companies have engaged in.

Often, a “whistleblower” is fired as a result of his or her complaints regarding illegal practices that he or she has discovered. A special law protects persons who report fraudulent company conduct that may defraud the federal government.

As much as one-third of all False Claims Act cases involve inflated and fraudulent Medicare and Medicaid billing by healthcare providers. Thus, individuals who may have a whistleblower or Qui Tam claim include people who work at companies that submit bills to Medicare, Medicaid and other government programs.

Examples of such companies would include labs, clinics, hospitals, nursing homes, dentists offices, ambulance companies, chiropractors, dialysis clinics and other medical providers.

Some kinds of Medicaid/Medicare fraud include:

• Double-billing (charging more than once for the same service)
• Billing for services that were not performed
• Billing for expensive equipment/services but actually providing cheaper equipment/services
• Inflating medical invoices sent to the government
• Using the wrong billing codes for treatment

The procedure for filing a whistleblower claim can be complicated. There are other legal requirements that must be met. If you believe that you may have a whistleblower claim, please contact John Hughes at 1-800-849-5291 or use this convenient form.