Qui Tam Cases: Tips for Whistleblowers

Monday, February 22, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law


At The Health Law Firm, we have represented many clients involved in qui tam cases brought because of false claims under the Medicare False Claims Act. If you are thinking about blowing the whistle on some sort of fraud or unlawful conduct by your current or former employer, there are important things that you should know.

Filing a qui tam case can be very complicated.  It is important to seek experienced legal counsel to guide you through the difficult process. It is crucial that the whistleblower's attorney have a good working relationship with the U.S. Attorney's Office and the State Attorney's Office. Based on our experience with these cases, here are some key tips to remember if you are thinking about bringing filing a qui tam or whistleblower's case.

1.     You Are Doing the Right Thing.  It is important to remember in qui tam cases that you are doing the right thing. Qui tam whistleblowers often save taxpayers millions of dollars and help the government recover stolen funds by coming forward with cases of fraud.  The government recovered over two billion dollars last year from these.

2.     Choosing Your Attorney Matters a Lot.  Because filing a qui tam suit under the False Claims Act (FCA) can be a difficult and complicated task, choosing an attorney with the proper experience can really make a difference. Litigation of whistleblower cases, either prosecuting them or defending them, is a highly complex, technical area of law and not all attorneys have the experience to make the process easier, let alone be successful.
3.     Don’t Drag Your Feet If You Have Evidence of Fraud.  Once you have evidence of fraud, you need to act quickly or you may lose your opportunity to receive a monetary award. The FCA limits the time in which a suit can be filed. Generally, a qui tam suit must be filed within six years of the date the fraud was committed. Most qui tam laws, including the FCA also have a “first to file” rule. This means that a qui tam whistleblower must be the first to file a case in order to be eligible to receive an award.  Additionally, if the fraud becomes public knowledge or the government discovers the fraud on its own, it is too late.

4.     The False Claims Act Does Offer Protection to Whistleblowers.  One concern clients have when filing a qui tam suit, is the effect it might have on their professional career as well as their personal life. While complete protection cannot be guaranteed, these types of cases have an anti-retaliation provision that makes it unlawful for an employer to retaliate against you for exercising your rights as a whistleblower. In addition, during the length of the government’s investigation, your identity is protected by the “seal” provision of the law, which prohibits the government from disclosing your identity to anyone without prior court approval.
5.     Be Aware of the Potential Risks.  Despite the FCA’s protection, there are still great personal and professional risks when filing a qui tam lawsuit. Despite the provisions, some whistleblowers lose or get demoted from their job. This is one of the reasons that successful qui tam whistleblowers are awarded with such large monetary awards: to compensate them for taking that career risk and for recovering the taxpayers' money back for the government.

6.     Silence is Golden in Qui Tam Cases. Do not discuss your case with anyone but your lawyer. Do not tell your friends. Do not tell your family. Do not even disclose that you are thinking of filing a lawsuit. Public discussions can be detrimental to your case. Qui tam suits are filed under the “seal” provision of the FCA, which prohibits the disclosure of any aspect of the case to anyone without prior court approval.
7.     Actual Documentation of False Claims is Needed. Recent court cases have strictly emphasized the requirement that you must have documented proof of actual false claims being submitted.  Whether these are copies of claims, copies of superbills copies of explanations of benefits (EOBs), copies of ledgers, copies of book keeping documents or whatever, you must have several actual claims that are false that were submitted for payment.  Internal memos, policies and procedures, billing guidance and instructions, medical record entries, and other documents that show the employer's intent to defraud the government are very useful. However, you must also have copies of false claims documentation, as well.

Those who file qui tam cases under the FCA are valuable and important for our nation’s health care system. They help stop health care fraud and help the government recover billions of dollars. Through qui tam lawsuits, whistleblowers have stopped harmful practices that endanger the health and lives of Medicare and Medicaid patients.

To read further on qui tam cases and how The Health Law Firm can assist you, click here.


Contact an Experienced Health Law Attorney to Assist in Qui Tam Cases.

If you have knowledge of false claims being filed against Medicare, Medicaid or any other type of government program, please contact us, and we will be happy to assist you. Our law firm represents health professionals and health care organizations almost exclusively. Yet, we have been involved in a number of whistleblower/qui tam cases, in which we represent the person who files the claim.

We have been involved in a number of qui tam cases, in which we represent the person who files the claim. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, and other experts that assist us in such matters.

The Health Law Firm and its legal professionals represent health care providers in health care fraud cases including False Claims Acts, Medicare and Medicaid fraud and qui tam or whistleblower cases. These include physicians, medical groups, mental health professionals, pharmacies, nursing homes, home health agencies, hospitals and other health facilities. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:

Phillips & Cohen LLP. “Pitfalls to avoid when filing a qui tam case.” Qui tam whistleblowers. (February 12, 2016). Web.

Tycko, Jonathan. “Top ten tips for qui tam whistleblowers.” The National Law Review. (September 22, 2014). Web.


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


KeyWords: False Claims Act (FCA) lawyer, submitting false claims, Medicare fraud attorney, whistleblower's lawyer, qui tam false claims act legal counsel, health care fraud attorney, false medical billing claims attorney, whistleblower defense attorney, False Claims Act defense lawyer, federal health care programs, qui tam defense lawyer, health care law attorney, health care fraud scheme, Medicaid fraud attorney, health care professional legal representation, health care fraud defense lawyer, health law, Florida health law attorney, The Health Law Firm

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
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2/22/2016

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