False Claims Act whistleblowers don’t have to have all the answers

| Nov 15, 2019 | False Claims Act |

Do you work in healthcare or another field where federal contracting is common? If so, you may have noticed fraud, waste or abuse in the fulfillment of those contracts. Have you considered blowing the whistle?

There is an important law you should know about: the federal False Claims Act. It was set up by Congress to give incentives to private individuals to blow the whistle on fraud or mismanagement. If you bring a successful case under the False Claims Act, you will be rewarded with a substantial percentage of whatever the government recovers through your efforts.

This is called a “qui tam” lawsuit. When you file one, you notify the Department of Justice and give it the evidence you have. At that point, the DOJ may intervene and take over your case. This is usually a good thing, as they will bring the full resources of the federal government to bear on the case, making it more likely that you will win. However, if the DOJ does not intervene, you can still move forward with the case on your own and stand to win a greater percentage.

How much money is at stake? A lot. When a defendant in a False Claims Act lawsuit is found guilty of fraud, they generally are required to pay three times the total loss sustained by the government, along with an additional $5,000 to $10,000 for every false claim it made.

When the government intervenes, qui tam plaintiffs receive between 15% and 25% of the full amount received by the government. When it does not, the plaintiff is entitled to between 25% and 30% of the recovery.

Depending on the exact circumstances, you could be entitled to a share of a million- or multimillion-dollar damage award.

Do I have to have first-hand knowledge and hard evidence?

Not necessarily. With the increasing complexity of fraud against the government, the Justice Department is looking for law-abiding people to help. Often, it’s enough that you have a general idea of what kind of fraud is occurring.

In the healthcare field, you might have noticed fraudulent activity such as:

  • Billing for services that were never provided
  • Billing more than once for the same service
  • Billing for unqualified service providers
  • Justifying more expensive services or procedures than necessary
  • Providing unnecessary services to Medicare or Medicaid patients
  • Self-dealing, where doctors refer patients to facilities they have a stake in
  • Kickbacks, where a facility pays a doctor for referrals

What is required to file a qui tam lawsuit?

Whether or not you are in the position to have direct knowledge of the fraud, you can file a qui tam lawsuit whenever you discover fraud against a government program that has not been publicly disclosed by others.

If the fraud has already been disclosed, you may still file a qui tam lawsuit if you have direct, independent knowledge of the fraud. You should contact a law firm that handles False Claims Act qui tam lawsuits before taking any action. The law firm can help ensure that you take all the steps necessary to put yourself in the best position to collect your reward.

Won’t I just get fired?

It’s illegal to retaliate against employees who file or participate in qui tam actions, but it does happen. You should discuss your concerns with your qui tam attorney to minimize the chances of retaliation. If your employer does retaliate, you could be entitled to double the amount of damages you sustain as a result.