What is a Qui Tam Case?

What exactly is a Qui Tam case (also referred to as “Whistleblower” cases)?

Under the False Claims Act, a private individual who has knowledge of either past or present fraud committed against the United States government may be able to file a lawsuit on behalf of the Federal Government.  This is called a qui tam case.

The False Claims Act allows people, commonly referred to as “whistleblowers”, who are not affiliated with the Federal Government to file actions on its behalf for fraudulent acts committed against the government. The Act provides legal recourse for the Federal Government if and when it is harmed due to fraudulent billings.

Who can bring a lawsuit in a Qui Tam Case?

Typically, people with some type of insider knowledge of false claims can file claims under the Act. Most claims filed relate to healthcare, the military, or other government spending programs.

The False Claims Act allows private persons to file a lawsuit for violations under the Act on behalf of the government. A suit filed by an individual on behalf of the government is known as a qui tam action, and the person bringing the suit is referred to as a relator.

A person filing suit under the Act does not need to have been personally harmed or injured by the defendant’s actions. Rather, the individual bringing the claim is recognized as having legal standing to sue by way of a partial assignment.

People who file a claim pursuant to the False Claims Act are eligible to receive a portion of any recovered damages, ranging from around 15% – 25%.

According to United States ex Rel. Lu v. Ou, 368 F.3d 773 (7^th Cir. 2004), a person may not bring a qui tam case pro se – without the representation of an attorney – under the False Claims Act.

If you believe that you have information about alleged fraud against the government, you should speak with an experienced qui tam attorney to discuss the next steps to take regarding your qui tam case.

How is the government harmed by nursing homes?

Since 2010, the types of individuals able to file a claim on the government’s behalf for fraudulent acts has widened, allowing for more people to file these qui tam/whistleblower suits. Prior to 2010, however, the only people who could file a claim were those who had insider knowledge acquired directly through working for the medical facility or entity.

The idea behind the False Claims Act, also referred to as the “Lincoln Law”, is that the government is paying out a lot of money for government spending programs, and it can become overly burdensome for the government to single-handedly determine who is cheating the system. This way, private individuals have an incentive to act as whistleblowers in these cases involving fraud.

A majority of qui tam cases involve Medicare and Medicaid fraud. Nursing homes, for example, may attempt to fraud the system by lying about the amount of treatment needed by its patients, or possibly by lying about the amount of treatment that has been provided.

To illustrate the point, a nursing home may order rehab or therapy for a patient who is either unable, unwilling, or does not need it. Since Medicare and Medicaid payments are determined in part by the amount of rehabilitation or treatment that a patient needs and receives, nursing homes or other healthcare facilities may lie in order to receive more substantial payments.

What should I do if I have a qui tam claim?

Cory Fein, Of Counsel for MedMalFirm.com Law Firm, recently provided a presentation to the firm on Whistleblower cases. He has handled whistleblower lawsuits against nursing homes, home health services, and other entities.

If you believe that you have a qui tam case, or whistleblower case, and would like to discuss the details with an experienced qui tam lawyer, contact MedMalFirm.com by calling 877-887-4850, or by filling out our online form.