How can you Blow the Whistle and file a Qui Tam Lawsuit?

In order to bring most qui tam or whistleblower lawsuits under the law you must use private counsel. While there are some matters you can bring without a qui tam attorney, federal False Claims Act (FCA) and/or various whistleblower state laws concerning the reporting of fraud in healthcare programs like Medicare, Medicaid and/or state law health care programs generally require a whistleblower lawyer to be involved. Based on the False Claims Act and other statutes your lawsuit may be viewed as a public good and as a reward you may be eligible for roughly 15–30% of the amount the government recovers, but that will be based on a variety of factors, such as the extent of the involvement, quality of the information, and the length of time the fraud occurred without you reporting it. Further, the First to File rule means the first person to blow the whistle may be entitled to an award, but even if you’re a day late you are not entitled to anything. Before you proceed with a lawsuit, you should be aware of a few things.

1) FOCUS on what the FALSE CLAIM actually is

The False Claim must be a materially false submission to the government for payment and it must make the payment. It sounds simple, but break down, what is false about the submission and did the government actually pay it. Since it is a fraudulent act, you must be able to specifically articulate the wrongful act, but a skilled qui tam lawyer or whistleblower law firm can assist with that.

2) DON’T INTERVIEW WITNESSES Yourself

As any whistleblower law firm will tell you, the Department of Justice (DOJ) looks to corroborate your allegations and will consider who else can support your allegations. If there are witnesses, at some point you may share their contact information with the government. However, by contacting them yourself you run the risk of turning them into Medicare whistleblowers. If they file first, your lawsuit can be barred by False Claims Act’s “first to file” provision.

3) Try to QUANTIFY the EXTENT of the False Claims

One of the questions the government will want to know is how much fraud has gone on. Qui Tam litigation is a matter of prioritization and the bigger the fraud, the more likely the government will dedicate resources to investigating and stopping it. As a rule of the fraud is in the mid seven figure range or above the government may intervene in a strong case. Below seven figures, it is doubtful they will undertake the matter and from 1 million to 5 million questionable. Still, no matter what the extent of the fraud is you should speak with a whistle blower firm to understand your rights.

4) Be REALISTIC

Fraud against the government is rampant but intervention only occurs in a fraction of cases. Often the amount of money the government can recover is the most compelling factor. You may want to consult a whistleblower lawyer for a more realistic assessment of recoverable damages. Also, things don’t happen right away. There’s a lot of hurry up and wait.

5) Seek the PROFESSIONAL ADVICE of a Qui Tam Lawyer

Navigating the statutes is complicated work. You need to comply with the pre-filing prerequisites and file the matter under seal. If you don’t file it properly, you may have inadvertently not blown the whistle, but instead blown your chance for a recovery. With Medicare whistleblower actions it is doubtful that you will be able to stay anonymous from start to finish, although initially your identity will be concealed until the lawsuit is unsealed. With SEC matters, you can blow the whistle yourself, but you can not remain anonymous. Many SEC whistleblowers come to us after they attempted to do it by themselves and have already damaged their case, sometimes beyond repair.

6) EDUCATE Yourself

Sometimes the Medicare fraud is so rampant that the industry treats the fraud as the norm. For example, a medical facility may consistently upcode a procedure and lead you to believe that is the acceptable industry practice. It is not! In our experience, the median medical fraud whistleblower needs to have an epiphany or show a more acute awareness towards the law and is better

educated than the average person on the street. Despite higher-than-average education, Medicare whistleblowers need to tread down this path cautiously. Extensive personal research and a reliable Medicare whistleblower law firm can help here.

Our firm is only paid if we win your case. We spend our time and money investigating the matter and if we don’t prevail, you don’t owe us anything at all. Call the whistleblower lawyers at Brown, LLC, 24/7 at 1 (877) 561-0000 to help you work through the entire qui tam process so that you can be confident of making an informed decision based on your best interests. We protect the whistleblower.

What records do I need to establish a case of Medicare Fraud?

Theoretically, anyone can be a whistleblower who has information about misconduct, but the law strongly favors whistleblower awards for those that have inside information. Under the False Claims Act (FCA), there is a growing body of law that suggests only an insider can recover a whistleblower award, but there are some outlying opinions that permit a whistleblower recovery if very specific information provided. With an SEC Whistleblower, it can be anyone if they can provide insight to the practice in which the financial company puts its own interests ahead of the consumers

Who can be a whistleblower?

Theoretically, anyone can be a whistleblower who has information about misconduct, but the law strongly favors whistleblower awards for those that have inside information. Under the False Claims Act (FCA), there is a growing body of law that suggests only an insider can recover a whistleblower award, but there are some outlying opinions that permit a whistleblower recovery if very specific information provided. With an SEC Whistleblower, it can be anyone if they can provide insight to the practice in which the financial company puts its own interests ahead of the consumers

How do I receive a whistleblower award?

Whistleblowers stand to receive considerable whistleblower awards if their case is successful. Generally, under the False Claims Act, if the government intervenes a whistleblower award is around 20% with an average settlement of around $13 million dollars. Of course, it is a long process with precarious pitfalls that needs to be navigated to avoid the perils and maximize the chance of a successful whistleblower lawsuit.

How do you file a qui tam lawsuit? How do I file a False Claims Act Lawsuit?

A Qui Tam Lawsuit, also known as a whistleblower lawsuit is generally filed pursuant to the False Claims Act (FCA), which requires the use of an attorney. The case must be filed under seal with proper notice given to the various government agencies on behalf of the whistleblower, also known as a relator.

What is a whistleblower lawsuit?

A Whistleblower lawsuit that’s actionable generally falls into a few categories. A False Claims Act (FCA) whistleblower action is when someone blows the whistle on when the Federal Government is defrauded. This type of fraud generally is Medicare Fraud, Medicaid Fraud, or Defense Contractor fraud. SEC Whistleblowers provide inside information where financial institutions fail to have the best interest of their clients in mind and practice. SEC whistleblowers provide information regarding price fixing, inside trading, self-dealing to name a few topics. Also, there are various state law protections for whistleblowers but certain states like New York, New Jersey, California, and Illinois have stronger state whistleblower protections that enable you to blow the whistle on certain types of insurance fraud or state tax fraud.

What is the whistleblower program?

The whistleblower program is what people colloquially refer to as the various statutes such as the False Claims Act or the SEC Whistleblower programs that allow whistleblowers to bring a qui tam action. It is not like the Witness Protection Program, although SEC whistleblowers may be able to remain anonymous with the use of an SEC whistleblower lawyer. Those filing False Claims Act cases, although initially filed secretively under seal, will have their identity disclosed at some point. The statutes entitle the whistleblower to a portion of the recovery known as a whistleblower award if there is a successful prosecution of a case that recovers money.

Will I lose my job if I report Medicare Fraud?

The law has very rigorous mechanisms to prevent you from losing your job as a whistleblower under the False Claims Act for Medicare Fraud. But you must blow the whistle the right way. Also, even though the company is not supposed to retaliate, it may illegally try to do so that’s why it’s important to retain an experienced whistleblower lawyer to guide you through the process.

I think I’m being seriously overbilled by Doctor – can I be a whistleblower?

Anyone can be a whistleblower, but if you don’t have information regarding the extent of the activity beyond the Doctor overbilling you then most likely it will not be a successful qui tam case. Rarely, these cases can be cobbled together through other intensive investigative techniques to make sense of the overbilling and to show it happens to others.

What’s the difference between the Stark Law and the Anti-Kickback Statute?

The Stark Law prohibits self-dealing. The Anti-Kickback Statute (AKS) prohibits paying referral fees or inducements for incoming business. For example, if a Doctor pays an illegal runner $50 per each patient referred to his practice that would violate the Anti-Kickback Statute. If the Doctor then went on to refer all the patients to a pharmacy in the building which he or she owns a piece of it is a violation of the Stark Law.

Do I need a whistleblower attorney to file a False Claims Act case over Medicare Fraud?

Yes. The Courts interpret the statute to mandate the use of a lawyer in filing a qui tam action under the FCA.

Is it legal for a medical provider to refer patients to a facility that the provider has a direct interest in?

If a medical provider either directly or indirectly refers a patient to a facility in which they have a direct economic interest it is generally a violation of the Stark Act. Penalties under Stark include  recovery of payments, imposition of a $15,000 per service civil monetary penalty for knowing violations, and a monetary fine of $100,000 for each arrangement found to have willfully circumvented the statutory scheme.  In an effort to prohibit medical providers from not acting in the best interest of their patients this is often enforced as a strict liability offense.

Does it make a difference if I report the fraud to the government directly or file a Qui Tam under the False Claims Act?

Yes. It makes a world of economic difference to you. If you use the mechanisms within the False Claims Act, you are eligible to receive a False Claims Act (“FCA”) award up to 30% of the government’s recovery. If you report it directly without filing a whistleblower action, then you are not entitled to a portion of the qui tam recovery.

Do you get money for being a whistleblower?

Whistleblower stand to receive very bountiful whistleblower awards if their case is successful. Generally, under the False Claims Act, if the government intervenes it is around 20% with an average settlement of around $13 million dollars. Of course, it’s a long process with precarious pitfalls that needs to be navigated to avoid the perils and maximize the chance of a successful result.

How do you file a qui tam lawsuit? How do I file a qui tam lawsuit?

A Qui Tam Lawsuit, also known as a whistleblower lawsuit is generally filed pursuant to the False Claims Act (FCA), which requires the use of an attorney. The case must be filed under seal with proper notice given to the various government agencies on behalf of the whistleblower, also known as a relator.

Is it legal for a medical provider to refer patients to a facility that the provider has a direct interest in?

If a medical provider either directly or indirectly refers a patient to a facility in which they have a direct economic interest it is generally a violation of the Stark Act. Penalties under Stark include recovery of payments, imposition of a $15,000 per service civil monetary penalty for knowing violations, and a monetary fine of $100,000 for each arrangement found to have willfully circumvented the statutory scheme. In an effort to prohibit medical providers from not acting in the best interest of their patients this is often enforced as a strict liability offense.

Does it make a difference if I report the fraud to the government directly or file a Qui Tam under the False Claims Act?

Yes. It makes a world of economic difference to you. If you use the mechanisms within the False Claims Act, you are eligible to receive a False Claims Act (“FCA”) award up to 30% of the government’s recovery. If you report it directly without filing a whistleblower action, then you are not entitled to a portion of the qui tam recovery.

Do I need a whistleblower attorney to file a False Claims Act case over Medicare Fraud?

Yes. The Courts interpret the statute to mandate the use of a lawyer in filing a qui tam action under the FCA.

I think I’m being seriously overbilled by Doctor – can I be a whistleblower?

Anyone can be a whistleblower, but if you don’t have information regarding the extent of the activity and that the overbilling effecting your case isn’t just an errant mistake then you will most likely not be able to make a successful case. Rarely, these cases can be cobbled together through other intensive investigative techniques.

What is a whistleblower lawsuit?

A Whistleblower lawsuit that’s actionable generally falls into a few categories. A False Claims Act (FCA) in which the government has been defrauded. SEC Whistleblowers where financial institutions fail to have the best interest of their clients in mind and practice. Various state law protections, which often times only address wrongful termination, but certain states like New York, New Jersey, California, and Illinois may have stronger state whistleblower protections.

What is the whistleblower program?

The whistleblower program is what people colloquially refer to as the various statutes such as the False Claims Act or the SEC Whistleblower programs that allow whistle blowers to bring an action. It is not like the Witness Protection Program, although the SEC whistleblowers may be able to remain anonymous, those filing False Claims Act cases, although initially under seal, will have their identity disclosed at some point. The statutes entitle the successful prosecution of a case that is attributable to the whistleblower a portion of the recovery.

What records do I need to establish a case of Medicare Fraud?

Certain Courts require more detailed information than others. Some Courts require a specimen of an illegal billing from start to finish. For example, if you know the practice is billing for services not rendered, or upcoding, or performing unnecessary services then to establish that case you may need to show the billing records and medical records that patient John Doe is a Medicare recipient who came in for a knee contusion and after a brief examination the practice fraudulently billed Doe for everything any anything wholly unrelated to the visit. This creates a tension, as you are not authorized to take record you wouldn’t ordinarily have access to, but should make copies of records that you have access to that show the fraud. Please do not rely on this paragraph for anything. You should retain a qui tam lawyer before engaging in the process of record copying to ensure you are in compliance with the law.

What’s the difference between the Stark Law and the Anti-Kickback Statute?

The Stark Law prohibits self-dealing. The Anti-Kickback Statute (AKS) prohibits paying referral fees or inducements for incoming business. For example, if a Doctor pays an illegal runner $50 per each patient referred to his practice that would violate the Anti-Kickback Statute. If the Doctor then went on to refer all the patients to a pharmacy in the building which he or she owns a piece of it is a violation of the Stark Law.

Who can be a whistleblower?

Theoretically, anyone can be a whistleblower who has information, but the law strongly favors whistleblower awards for those that have inside information. Under the False Claims Act (FCA), there is a growing body of law that suggests only an insider can recover, but there are some outlying opinions that discuss otherwise if there is very specific information provided. With an SEC Whistleblower, it can be anyone as well as long as they can provide insight to the global practice in which the financial company puts its own interests ahead of the consumers.

Will I lose my job if I report Medicare Fraud?

The law has very rigorous mechanisms to prevent you from losing your job as a whistleblower under the False Claims Act for Medicare Fraud. But you must blow the whistle in the right way. Also, even though the company is not supposed to retaliate, it may illegally try to do so, it may conduct a mole hunt when they are alerted there is a whistleblower and may act in other unconscionable ways to make life more difficult.