Qui Tam Whistleblower: Is your employer defrauding the government?

January 10, 2019 – Each year, the United States recovers billions of dollars lost to fraud and false claims made against the federal government. In 2017 alone, over $3.7 billion in settlements and judgments were recouped by the government, nearly $2.4 billion of which involved false claims made by the healthcare industry, including hospitals, pharmacies and drug companies. These recoveries are made possible in large part because of qui tam whistleblowers—employees and private citizens who make the report and expose the fraud.

The federal government, as well as states like Minnesota, have laws aimed at stopping government fraud. These laws are called False Claims Acts, also known as qui tam statutes, which permit citizens to bring suits on behalf of the government. These laws are intended to be an incentive to citizens to report known fraud involving any federally funded contract or program by allowing the qui tam whistleblower to recoup up the 30 percent of the total funds recovered.

Qui Tam Lawsuit

A qui tam lawsuit is a way for an employee-whistleblower or private citizen to assist the government in prosecuting entites engaged in fraud in their relationship with the government. The person bringing the lawsuit (a whistleblower) is known as the “relator.” While private citizens can play a role in reporting government fraud under the False Claims Act, qui tam whistleblower cases often arise in the employment setting.

In general, False Claims Act cases arise in three contexts:

  • A company makes a mirepresentation that leads to government reimbursement under a contract.
  • A company fails to disclose, or omit, a fact that would lead the government to reduce or withhold payments.
  • A company misrepresents or omits a fact to reduce the amount of money owed to the government.

Qui tam actions are an acknowledgment by the government that fighting fraud requires a joint effort between private citizens and the government. At the outset of the qui tam lawsuit, the case is presented to the United States Attorney’s Office (Department of Justice), and the government makes a determination whether to actively assist in the litigation of the action.

Qui Tam Whistleblower and Healthcare Fraud

False Claims Act lawsuits often arise in the health care industry. Any fraudulent claim submitted to either Medicare or Medicaid constitutes fraud on the government. In many cases, it is employees of these healthcare organizations who uncover and report the fraud. Examples of healthcare fraud include: billing for services that were never provided; performing unnecessary medical procedures to increase reimbursement; performing excessive lab tests when not medically required; and billing for brand name drugs when generics are provided.

For more information about False Claims Acts and qui tam whistleblower lawsuits, click here.

Contact Our Qui Tam Whistleblower Lawyers
Baillon Thome Jozwiak & Wanta LLP is committed to holding companies accountable for government fraud. If you believe you have evidence of a fraud on the government, contact our whistleblower lawyers to discuss your rights. Our attorneys will work with you to review the evidence, evaluate any potential claims and discuss your rights. Contact us by clicking here for a free initial consultation.