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The false claims act is a federal law that is also sometimes called the “Lincoln Law.” This is the law that sets liability for those who defraud governmental programs. This law has been around and active on the books since the Civil War. It was originally started to help stop fraud against the government potentially caused by suppliers to the Union Army. However, in 1986 there were several mishaps by the department of defense contracting industry that brought on new amendments. Since those amendments, in the last three decades, over $48 billion dollars has been recovered on behalf of the government. With nearly half of the total recovered as a direct result of health care related cases.
Whistleblower and Qui Tam are provisions within the false claims law that allows others to file legal action for the government, even if they may be a party in the suit. The “others” that are allowed to file suit on behalf of the Government are not part of the government, and they are called realtors. These provisions were put into place due to the simple fact that our government doesn’t have the capacity to investigate all of the fraud and false claims that are submitted. Instead, private citizens have the ability to file suit on behalf of the government, submit evidence of fraud, and also receive monetary rewards sometimes up to 25% of any money that is retrieved from the suit.
Medicare and other healthcare fraud has taken over as a majority of these types of cases. While many Americans use privately held insurance, millions of Americans rely 100% on governmental programs and assistance such as Medicare. Due to the abundance of people using these programs, sometimes it is very hard to detect the fraud that is occurring. The fraud occurs when doctors or Medicare providers and facilities engage in behavior such as billing for services not rendered, billing for patients that were never seen, using billing codes that represent a more expensive treatment than which was actually preformed, billing for individual testing procedures instead of bundling them into one fee, and even billing for unnecessary medical tests and treatments.
Another form of suit that is becoming prominent is based on shareholders civil lawsuits filed Qui Tam, against their companies on behalf of the government. In one case like this, a software company that supplies it’s product to the government, did not disclose deep discounts and incentives given to private and commercial companies, while charging the federal government premiums that were highly inflated. The fraud was uncovered when a former senior executive filed a whistleblower action. In this case, the allegations were settled. The company agreed to pay $199.5 million dollars back to the government, less the $40 million that went directly to the former executive as a monetary reward for exposing the fraud.
If you would like to file a claim, or a whistleblower lawsuit, several very specific procedures must be filed for you to in fact receive the reward. The majority of the case will rely on evidence or proof you have of your claim. Facts on paper, emails, sales receipts, etc. anything that is solid evidence that your company was committing the crime will be submitted as evidence. If you have evidence of such fraud, you should contact a Qui Tam attorney immediately. They will review your documents, and determine if there was fraud, and if it falls within the statute of limitation to bring a case. Next they will draft what is called the Relator’s statement. This statement will serve as a complaint that explains to the government what exactly you are accusing or blowing the whistle on. This document gets filed first under seal with the attorney general and the US Attorney, then later is filed under seal with the US District Courts. Once that has been completed, the government will do their own investigation and determine if they would like to join the suit. For you to receive any benefit or award settlement, the government must join. After that, the case will either be litigated and decided upon by a judge, or settled out of court. Either way, once the case is “won” you will receive an award for coming forward.
Some recent Whistleblower’s Act claims that were litigated and won include a lawsuit against Respironics, a company that sells masks for people with sleep apnea. This lawsuit yielded a 34.8 million dollar gross to be paid, 5.38 million of which was rewarded to the Doctor that originally brought the suit. EV3 is a medical device company that allegedly convinced several hospitals to admit patients for a procedure prior had only been an outpatient procedure. In this suit, 1.25 million dollars was recovered. Another medical device company settled their case for $6 million dollars after being accused of participating in cash kickbacks to the doctors who referred patients to use its devices. One of the former product managers for the company came forward in her Qui Tam suit, and her recovery amount is not yet determined.
These cases are very complicated from the legal standpoint, but if you have proof that your employer or some other business is defrauding the government, an attorney will make the process easy on you. As well, there are anti-whistleblowers laws in place now that will protect you from any sort of retaliation. Call or e-mail us at any time to ask questions or for help in finding the right type of lawyer for the fraud you want to expose.