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Category: Qui Tam

Health Co. Asks High Court To Rein In FCA Pleading Rules

Posted on by Mike Bothwell
Healthcare Company Whistleblower Lawyer

Full Article here.

Molina Health has urged the U.S. Supreme Court to rein in pleading requirements for False Claims Act whistleblowers, saying that a circuit divide has loosened standards that will become a broader cudgel for contractual and regulatory issues.

The managed care firm — accused by former contractor Thomas Prose of improperly billing the government for Medicaid services — says the high court must reverse a Seventh Circuit decision and instead conclude that Federal Rules of Civil Procedure Rule 9(b) requires whistleblower-plaintiffs like Prose to allege specific false claims that Molina may have made to the government.

The company also wants the court to rule that an omission alone doesn’t necessarily constitute a false or fraudulent claim under the FCA, according to the writ, filed Feb. 14. Molina warned that inaction or an adverse ruling would further transform the FCA — meant specifically to catch fraudulent billing — into a dragnet for “fishing expeditions,” according to the writ.

“The FCA is one of the most frequently litigated statutes in the U.S. Code,” the writ argues. “Unless this court grants certiorari and holds that a request for payment that makes no specific representations cannot be treated as if it contains an implied false certification, the FCA will become precisely what this court has warned against: ‘a vehicle for punishing garden-variety breaches of contract or regulatory violations.'”

According to Prose’s 2017 lawsuit, his company GenMed ended a contract to provide Molina with care coordination services at nursing homes, but Molina kept billing Medicaid as though GenMed was providing the services. The government paid Molina a set rate per patient regardless of specific services they received, and Molina says it didn’t make fraudulent claims because it never requested payment for specific required services it did not provide.

U.S. District Judge Virginia M. Kendall dismissed the lawsuit against Molina in June 2020, finding that the allegations weren’t specific enough, but the Seventh Circuit reversed that decision last year.

The appellate court concluded in a 2-1 decision in August that Prose has plausibly argued that Molina unit Molina Healthcare of Illinois knew that services it failed to provide were a material part of its Medicaid managed care benefits contract. It also concluded that submitting a claim to the federal government carries the “implied” certification that a claimant complied with the underlying conditions of their contract, meaning an omission is tantamount to a false claim.

Chief Circuit Judge Diane S. Sykes issued a strongly worded dissent, asserting that her colleagues’ position broke with the circuit’s own precedent on Rule 9(b) and conflicted with the high court’s landmark ruling in Universal Health Services Inc. v. United States ex rel. Escobar page2image38116464, which rejected “implied” certification as a theory of FCA liability and found that an alleged false claim must be material to the government’s decision to pay, according to the writ. Molina raised similar arguments in a petition for en banc review last month.

The Eleventh Circuit joined five other circuits — the Third, Fifth, Ninth, Tenth and D.C. — in relaxing false claim pleading requirements, according to the writ. The First, Second, Fourth, Sixth, Eighth and Eleventh circuits have all held that plaintiffs must state particular false claims.

The split has long vexxed whistleblowers and government contractors alike.

A number of courts have also addressed the omission question, with the Fourth, Seventh, and D.C. circuits holding that omissions can constitute false or fraudulent statements, and the Third, Fifth, Ninth, and 11th circuits finding otherwise.

The divide has come before the high court several times before, periodically drawing the justices’ attention, but never winning certification. Two other petitions pending before the Supreme Court raise identical questions about specificity of claims, but the justices should take up Molina’s petition, the Fortune 500 company says, because it raises the additional question about whether an omission constitutes a falsehood.

Alternatively, the court should hold its petition pending a decision in either of those cases — Johnson et al. v. Bethany Hospice and Palliative Care LLC from the 11th Circuit and United States ex rel. Owsley v. Fazzi Assocs. Inc. out of the Sixth Circuit — if it decides to review them instead, Molina said.

Last month, the Supreme Court invited U.S. Solicitor General Elizabeth B. Prelogar to weigh in on the Bethany case, which involves a Georgia hospice company’s alleged kickback scheme.

Prose attorney Bruce C. Howard told Law360 on Tuesday that the Seventh Circuit ruling should stand.

“We continue to believe that there’s little likelihood that the Supreme Court will grant the petition for cert,” he said. “As Molina noted, one of the issues is already subject to a pending petition. Secondly, the Seventh Circuit unanimously denied a petition for rehearing en banc. We believe they got it right.”

Prose is represented by Bruce C. Howard of Siprut PC, and Neil M. Rosenbaum, Damon E. Dunn and Paul M. King of Funkhouser Vegosen Liebman & Dunn Ltd.

Molina is represented by Kelly Perigoe, Albert Giang, Jeffrey S. Bucholtz, Ashley C. Parrish, Quyen L. Ta, Anne M. Voigts, and Matthew V.H. Noller of King & Spalding LLP.

The case is Molina Healthcare of Illinois Inc. et al., Petitioners v. Thomas Prose, case number 21- 1145, in the U.S. Supreme Court.

Full Article here.  |  The Bothwell Law group does not claim ownership of this article.

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About the Bothwell Law Group:

Since 1996, the Bothwell Law Group has earned a national reputation for successful representation of whistleblowers in federal and state courts across the United States, and is one of only a handful of firms exclusively representing whistleblowers. Bothwell Law Group’s cases have resulted in the recovery of more than $400 million for the United States treasury and in the payment of millions of dollars in whistleblower rewards. Inquiries may be directed to Mike Bothwell at (770) 643‐1606, email Mike@WhistleblowerLaw.com.

Trump & our thoughts on why we should protect Whistleblowers

Posted on by Mike Bothwell

USA Today recently published the following article “Trump’s allies want to ID the whistleblower, who may learn the price of speaking out“.

Here are our my thoughts.

Shortly after signing the Declaration of Independence, the Continental Congress passed a resolution for whistleblower protection.  Some sailor and marines blew the whistle on a commander of the navy during the war with Great Britain.  They reported the problems to the Continental Congress and were prosecuted for it.  The Continental Congress not only passed the resolution supporting blowing the whistle on such abuse (calling it a “duty”), but it passed a subsequent resolution to pay the costs of their defense.

Another major whistleblower legislation was passed in 1863 during the Civil War.  The False Claims Act also known as the Lincoln Law allowed private citizens to sue on behalf of the government to recover for false claims and fraud against the government.  This law was significantly revised in 1985 and has become the government’s number one tool for prosecuting fraud against the United States.  Whistleblowers recover from 15% to 30% of what the government receives and cases under the False Claims Act have brought in $60 billion since it was revamped in 1985.

Various state and federal agencies have passed whistleblower protections and evinced a consensus that whistleblowers play a crucial role in ferreting out fraud, waste, and abuse in our system.  In 1985, when Congress was considering one of the oldest and most robust whistleblower statutes (the False Claims Act), it noted that the act was underutilized in large part because of fear of retaliation.  That is perhaps the number one deterrent to people shinning a light on corruption and illicit dealings.  From July 30, 1778 to the present, America has agreed to protect people who are willing to bring bad things to light.

We absolutely need to continue this protection. I’m fighting for this daily.

What Is a Qui Tam Medicare Lawsuit?

Posted on by Mike Bothwell

Understand the importance of a qui tam Medicare lawsuit.

Qui Tam Medicare LawsuitDo you know what constitutes a qui tam Medicare lawsuit? Medicare is a government-funded healthcare plan. It provides eligible citizens with affordable healthcare options. The system relies on honest workers and a reliable healthcare system to make sure it operates smoothly. However, not all healthcare workers play by the rules. And, if they defraud Medicare, they should expect to get caught and pay the price.

The Role of Private Citizens in a Qui Tam Lawsuit

Qui tam comes from a longer Latin phrase meaning, “as the king as well as himself.” This type of lawsuit allows citizens to pursue legal action on behalf of the government. Today, the majority of these lawsuits fall under the False Claims Act. The government passed this legislation to encourage citizens to come forward with information.

The term relator applies to those citizens who bring forth a qui tam lawsuit or whistleblowers. In the world of Medicaid fraud, whistleblowers play an important role in exposing and stopping criminal activity.

Common Types of Medicare Fraud

Those receiving care from a hospital, nursing home, or hospice should pay close attention to what goes on around them. Many reported Medicare fraud cases directly affect patients. Doctors may “over-diagnose” a patient to get a kickback from Medicare. Some healthcare works will even change a patient’s prescription to another drug for unethical reasons.

Patients may notice inconsistencies with their healthcare provider, but few report them. Many of the whistleblowers are actually employees. Here are some of the most common types of Medicare fraud reported:

  • Overcharging for procedures or charging for procedures never administered
  • Partially filling medications but billing for the full dosage
  • Raising prices for Medicare patients
  • Ordering unnecessary tests
  • Changing diagnostic codes
  • Falsifying a patient’s records to justify more costly treatments

Medicare fraud is very dangerous. It can significantly affect the quality of life for patients. This is especially true if the doctor prescribes drugs or treatments that are not medically necessary. Too many patients, however, don’t recognize the warning signs of fraud. Patients trust their doctors and healthcare workers to provide them with honest service. Unfortunately, Medicare fraud is more common than people realize. Some estimates report Medicare fraud affecting between 8% and 10% of claims.

Protections Provided to Relators with the False Claims Act

Speaking up about wrongdoings is the right thing to do, but many people are afraid to come forward. Those committing Medicaid fraud don’t want to get caught. The legal ramifications for cheating the government are very harsh. Guilty parties may find themselves serving time or paying a hefty fine.

When someone blows the whistle on Medicaid fraud, they’re putting themselves at risk. Those running the scheme may try to silence them. However, the False Claims Act helps to protect whistleblowers from retaliation. It makes it illegal to threaten, harass, suspend, or fire a relator. It’s important to note that each state imposes its own statute of limitations.

Money Awarded to Whistleblowers with the False Claims Act

Whistleblowers can expect to receive something in return for their help. Under the False Claims Act, they receive a percentage of the money the government is able to recover. Most of these awards fall between 15-30 percent of the settlement.

Depending on the size of the case, this can be a large amount of money. The total amount is also dependent on whether the government intervened in the case. It’s not uncommon for a whistleblower to receive millions of dollars for their help in cracking a Medicare fraud scheme.

With the risk of retaliation so high, even with protections in place, the monetary award is the only reason some relators speak up. Thanks to whistleblowers, the Department of Justice was able to recover over $2.5 billion in 2018. Without private citizens reporting tips, the majority of fraud cases would still go unnoticed.

The Role of a Lawyer in a Qui Tam Lawsuit

If you have information about possible Medicare fraud, the government wants you to report it to the Office of the Inspector General. While you may want to let everyone know, it’s best to keep it to yourself. You never know who you may upset in the process, and for your safety, you should stay anonymous for as long as possible.

Before reporting your tip, however, be sure to consult with a lawyer who handles whistleblower lawsuits. Your lawyer will do everything possible to protect your identity and make sure you get your full settlement. Never try to represent yourself. Contact the skilled qui tam Medicare attorneys at Bothwell Law Group by calling 770.643.1606 today.

Who Is Responsible for Qui Tam Attorney Fees?

Posted on by Mike Bothwell

What do you need to know about paying the qui tam attorney fees? Find out here.

qui tam attorneys feesPeople who file a whistleblower lawsuit are often concerned about qui tam attorney fees. The common perception is that it will cost a lot of money out of your own pocket. This can make it seem like a qui tam lawsuit is a gamble, especially if you’re unsure of the case’s merits. However, the expenses in these cases usually come out of any recovery that you receive. This article explains how it works.

Contingency Fee

A whistleblower attorney usually performs an initial review of a case for free. Once the attorney decides to take the case, you can retain the attorney on a contingency basis. This arrangement means that you will pay the attorney only if the case is successful and you receive a reward from the government. An attorney who works on a contingency basis pays all expenses needed to represent you. These expenses include the costs of hiring expert witnesses, traveling, and completing documentation. They are also entitled to seek reimbursement of these expenses from the defendant if the case is successful.

The Whistleblower’s Reward

Your reward will be a percentage of what the government recovers in the event the suit is successful. This percentage can range from 15 to 30 percent of the total recovery, dependent on several factors. The most important of these is whether the government decides to pursue the case. Your percentage of the recovery will be less with government intervention.

Another factor that helps determine your reward is the value of the information you provide. Information with greater value will result in a higher reward. Your role in the case is also a factor the court will consider when assessing your percentage of the recovery.

The recovery in these cases can be up to three times the damages to the government plus the civil penalties. Each act of fraud can incur a separate penalty, which can be up to $11,000. Qui tam cases can include hundreds of separate acts, so the recovery amounts can be quite large.

Starting the Case

Initiating a qui tam case costs very little even if you don’t have an attorney yet. It does incur a filing fee and other minor administrative expenses. This means you can take a qui tam case some distance without spending any significant money up front, even without an attorney.

Government Intervention

You need to inform the government about the facts of your case once you file it. This allows the government to begin investigating your claims. The government will keep your case secret during this phase to prevent the defendant from hiding or destroying evidence. You should not discuss the case with anyone other than your lawyer and the government officials investigating the case.

The government may decide to take over the case at this point. In this case, you shouldn’t incur many expenses since your attorney won’t be prosecuting the case. Government intervention also means you have a strong case, so you’re more likely to receive a reward.

No Government Intervention

You still have the option of pursuing your case even if the government declines to prosecute it. You should not have to pay anything up to this point, including attorney fees or other expenses. This option has a greater risk because there may be costs involved from this point. However, you will also get a more significant share of the recovery if you win.

You will need to have a detailed discussion with your attorney at this point to determine if you will proceed without the government. In particular, you need to know if the attorney fees are likely to exceed the reward you receive. It’s also important to know when you would receive the reward, as qui tam cases can take years to decide. Another factor to consider is that you may become unemployable in your current profession if you become known as a whistleblower.

Recovering Expenses and Qui Tam Attorney Fees

Most qui tam cases fall under the False Claims Act (FCA), although the federal government has other qui tam laws. The FCA provides that whistleblowers may be eligible to recover legal costs from the defendant in addition to the reward itself. These expenses can include attorney fees and other costs associated with trying the case.

A whistleblower has the standing to recover these fees, not the whistleblower’s attorney. Furthermore, the whistleblower generally receives these fees directly, rather than the attorney. Reimbursement requires the whistleblower to have an attorney-client relationship with an attorney. This rule applies even in cases where the whistleblower is an attorney.

Understanding the fees related to whistleblower cases can be confusing. Get all of the information you need about qui tam attorney fees by contacting Bothwell Law Group today at 770.643.1606.

What Happens in Medicare Qui Tam Cases?

Posted on by Mike Bothwell

Learn more about the process for Medicare qui tam cases.

Medicare Qui Tam CasesPrivate individuals use Medicare qui tam cases to show that a person or group has committed fraud against the government. The term “qui tam” is from a Latin phrase. It refers to someone who pursues legal action on behalf of the government as well as themselves. It originated in 13th century England, where it has since fallen into disuse. However, the United States still uses qui tam writs under the False Claims Act and a few other more specific laws. Cases of fraud against the government are the most common types of qui tam cases, especially in Medicare and defense contracting.

Qui Tam Overview

A private individual files a qui tam lawsuit on behalf of the federal government, usually under the False Claims Act. This individual, also known as a relator, is the plaintiff in a qui tam suit. People often refer to these suits informally as “whistleblower” suits. However, this term is overly broad, as the U.S. has other whistleblower laws besides the False Claims Act.

History of Whistleblower Law

The U.S. Congress originally enacted the False Claims Act during the Civil War. This legislation was in response to widespread fraud by government contractors against the Union Army. Congress removed many of the incentives for whistleblowers to come forward in World War II.

Congress restored these incentives in 1986, and the number of qui tam suits has multiplied since then. Lobbyists for the healthcare and defense industries have often attempted to weaken the False Claims Act since 1986. However, these efforts have generally been unsuccessful. The U.S. government has recovered about $40 billion since the 1986 reforms. Whistleblowers have received over $4.2 billion of this total.

Qualifying Acts

The False Claims Act generally covers false claims in federally funded contracts and programs. These programs include Medicare and Medicaid. Specific acts include submitting false claims for payment or causing the submission of those claims. They also include making false statements to get fraudulent claims paid. The concealment of records of fraudulent claims is another violation of the False Claims Act. Additional acts that can result in a qui tam suit include conspiring to defraud the government.

The most common type of false claim is one for products or services the claimant never provided. It also includes payment claims that violate contract, regulations, and statutes. Each false claim may constitute a separate violation of the False Claims Act. This provision means that qui tam suits often charge the defendant with a large number of violations.

The deadline for filing a qui tam suit under the False Claims Act is the greater of the following:

  • Six years after the violation
  • Three years after the government should have known about the violation

In no event can a relator file suit more than 10 years after the violation.

Defendant Liability

The defendant in a qui tam suit is potentially liable for three times the value of damages to the government. The defendant is also subject to civil penalties for each false claim. These can include invoices, demands for payment and other payment documents. These penalties can range from $5,500 to $11,000 for each claim. Many specific documents can form the basis for a qui tam suit, depending on the industry. The forms for Medicare cases include the following:

  • Medicare enrollment forms
  • CMS Form 1500
  • Form UB-92
  • Cost report forms
  • New drug and abbreviated new drug applications
  • Pharmaceutical pricing reports

Pharmaceutical pricing reports include ASP data forms and Medicaid rebate quarterly reports.

Relator Compensation in Medicare Qui Tam Cases

A person must file a qui tam suit to be eligible for compensation under the False Claims Act. It isn’t enough to just inform the government about a false claim. Furthermore, the government must recover money as a result of the suit before the relator can receive compensation.

A relator should receive between 15 and 30 percent of what the government recovers. This range applies whether the case results in a settlement or favorable verdict. The exact amount primarily depends on the significance of the roles that the relator and government play in the case. A more significant contribution by the relator increases the compensation. A more significant contribution from the government decreases the compensation.

The relator’s compensation is generally between 15 and 25 percent of the recovered damages if the government joins the lawsuit. If the government doesn’t intervene, the relator should receive between 25 and 30 percent of the recovery. Each relator gets a portion of the total compensation in qui tam cases involving multiple relators. The individual contribution of the relator determines the portion each individual receives.

If you are aware of fraud, you have protection in Medicare qui tam cases under the False Claims Act. Contact the skilled attorneys at Bothwell Law Group by calling 770.643.1606 today.

What You Should Know about Qui Tam Cases and Defense Contractors

Posted on by Mike Bothwell

Let’s talk about how qui tam cases and defense contractors can turn out.

Qui Tam Cases and Defense ContractorsIf you suspect fraud, it’s time to consider how qui tam cases and defense contractors mix. This is especially true when you have information about a contractor misusing funds, but you may not be sure what to do. You might worry about the repercussions that you could experience for speaking up. If you’ve watched others suffer consequences for calling out others at work, you may be especially nervous. If you have a working relationship with the contractor, you may worry about losing their services.

Know that you are not alone. Many people have struggled with whether to blow the whistle on bad behavior throughout the history of the United States. While the decision to speak up is a personal one, you could be safeguarding countless lives by doing so. Let’s talk about the laws that protect you from negative repercussions for initiating qui tam cases against defense contractors.

What Are Qui Tam Laws?

Qui tam means “who as well,” or the filing of a lawsuit for the government as well as the plaintiff. Further, qui tam laws provide legal protection and enable private citizens to pursue legal action on behalf of the United States government. Qui tam laws work to push private citizens to speak up when they notice fraud. In 1863 the government created qui tam laws during the Civil War when the government was losing millions due to misrepresented claims about war equipment. The fraudulent claims put the safety of soldiers at stake. Something had to happen to protect the people who knew about the false claims. These private citizens needed to feel safe enough to speak up.

What Exactly Is a Whistleblower?

We’ve all heard the term before, but what exactly does it mean to be the one who sounds the alarm on fraudulent activity? The common name for a person who is working within the qui tam system is whistleblower. You may also hear them referred to as relators.

One of the ways qui tam laws protect whistleblowers from repercussions is by keeping their identities secret. The law provides incentives for citizens to take action when they notice wrong-doing. As a whistleblower, you can receive some of the funds recovered by the government based on the information that you provide. As a government employee, you already know that the misuse of government funds is rampant. When you report, you’re protecting valuable tax dollars.

Two Types of Qui Tam Cases

There are two categories of qui tam cases when it comes to defense contractors. The first happens when the contractor provides the government with false information about the service or product they produce. This can be misrepresenting the product delivered. This can also mean falsifying claims about testing that prove the efficacy of the product.

The second happens when the contractor mischarges the government for services rendered. This can mean overcharging, that the service was not up to par, or that the contractor overstated the number of hours worked.

When a company misrepresents the product they provide to the military, they could be putting the lives of troops at risk. When they misrepresent testing that on a product, they could be endangering people. Whistleblowing is not only an obligation for someone who witnesses the fraud, but it’s also an opportunity to save lives. In one of the most famous qui tam cases, a government contractor misrepresented testing done on military helicopters. Because of this, a helicopter crashed over the Saudi Arabian desert. The ensuing lawsuit enabled the United States government to recover the entire cost of the aircraft.

Qui Tam Cases and Defense Contractors: Rewards and Protection

The U.S. government recognizes that doing the right thing in these cases isn’t always easy. When the government recovers funds in a qui tam lawsuit, a percentage of that money goes to the whistleblower. The amount that you receive after the case closes will depend on the amount of money recouped by the government. You are also entitled to protection from potential repercussions enacted by your employer.

Though qui tam laws are there to keep you safe, some employers may still attempt to take action against you for filing. The laws put in place to protect whistleblowers ensure that you can regain anything you lost while exposing the wrongdoings of contractors. Reinstatement if you lost your job, double back pay of lost wages, and compensation for attorney’s fees and other legal costs incurred are possible with Qui Tam. It’s essential that you work with a lawyer who understands how these laws work, protecting you from mistreatment for doing the right thing.

Protect Yourself- Call Us

If you’re ready to look into qui tam cases and defense contractors, work with an attorney who has experience with this type of case. Don’t try to do this alone – you need legal protection. Contact the skilled attorneys with extensive experience with qui tam cases at Bothwell Law Group today.

What Are the Required Skills of a Medicare Qui Tam Attorney?

Posted on by Mike Bothwell

Discover the top traits of an experienced Medicare qui tam attorney.

Medicare Qui Tam AttorneySelecting the right Medicare qui tam attorney is more important than ever before. Over the past ten years, the number of qui tam cases has increased. Nuisance cases have the potential to cost the government a fortune. Preventions are in place, but you have to be careful they don’t interfere with your ability to file a case.

In 2018, the director of the Commercial Civil Fraud Division of the Department of Justice released a memo encouraging government lawyers to do a more stringent job of evaluating cases. More than that, it encouraged prosecutors to file motions to dismiss cases in certain situations to avoid contradictions in law and government waste. Over the past year, they’ve ramped up the number of dismissed cases, but often for a good reason.

For example, the government recently filed to dismiss 11 cases across seven federal districts, all raised by the same firm. The motion specifically called the lawsuits “meritless” and pointed out the case encroaches on policies put into place by federally mandated health programs.

The lawsuits’ main complaint? Pre-authorizations for prescriptions and providing patients with the education needed to use medications correctly are incentives in violation of the Anti-Kickback Statute.

It looks like the firm was using technicalities in the hopes of securing a payoff, and the government rightly put a stop to it. Is any part of their case valid? We’ll never know. It’s possible they’re working to stop a real problem that wasn’t clear in the filing. Working with the right lawyer ensures your case will stay active and get the support it deserves.

How do you know which lawyer is qualified? Keep an eye out for these traits and skills:

They’re Professional

When researching lawyers, make sure you’re looking at real lawyers and not someone who is misrepresenting himself to get your contact information. Referral services can look convincing, and their platforms make it easy to get the details of your case.

You also have to keep a lookout for a different kind of fake. Whenever you’re raising a qui tam suit, you have to file your claim appropriately to have whistleblower protections — and rewards. Pass your information to the wrong person, and they can attempt to raise the claim first. They could also contact the intended defendants to help them get a leg up.

It helps to check with the state bar association in your lawyer’s area to ensure they’re a true professional.

They’re Experienced

Winning lawyers aren’t experts in every area, and Medicare qui tam suits have very specific guidelines to follow. While you might not be able to stay anonymous, there are certain things you can do to protect yourself if you come forward. For instance, your employer cannot do any of the following if you have filed a whistleblower case:

  • Fire you
  • Demote you
  • Fail to advance you
  • Harass or threaten you

In some instances, an experienced attorney can help you preserve your anonymity or take extra measures against retaliation.

Most importantly, when included in a qui tam lawsuit, you’re eligible to receive a portion of any settlement or lawsuit winnings. Successful whistleblowers have received millions of dollars. There’s a lot at stake, so you want to work with someone you know will get things right.

They’re Well Connected

With the crackdown on frivolous qui tam lawsuits, who you know might become more critical over time. While the DOJ acknowledges how important cases are in keeping corruption at bay, the number of cases filed has reached a tipping point where the potential costs involved in intervention might outweigh the benefits of catching certain crimes.

Government intervention helps improve your chances for success, so hire someone who has worked alongside government agencies in the past. Bring in a lawyer with a reputation for filing and winning valid cases. It can help convince an agency your lawsuit is worth the investment.

They’re Ready for a Fight

Filing Medicare qui tam lawsuits don’t typically require a considerable cash investment up front from the client. Instead, the lawyers take their fees from the case winnings. Others charge per hour or per motion. It’s essential you understand billing procedures before you sign on with a legal professional. Will your lawyer be able to invest the time and money into preparing your case?

With so many considerations to make when choosing a lawyer, it pays to do your research. Every minute spent on research goes toward a winning settlement. Learn more about finding the right Medicare qui tam attorney by contacting Bothwell Law Group online.

How the Qui Tam Act Rewards People Who Come Forward

Posted on by Mike Bothwell

Wonder how the qui tam act rewards whistleblowing? Your bank account wants to know.

Qui Tam Act RewardsThe qui tam act refers to provisions of the False Claims Act (FCA) that make it possible for individuals to sue corrupt companies on behalf of the U.S. government. Cases must meet specific requirements to go forward, but successful wins result in big rewards. According to the Department of Justice, qui tam rewards going to filers topped $393 million in 2017. These cases are the government’s best weapon against fraud in government spending.

If you’re reading up on qui tam lawsuits, you’re probably worried about a situation at work. While laws are in place to protect you from retaliation, it can still be enough of a concern to keep people from speaking out. Sharing in the financial awards or settlements of FCA cases helps lessen the burden whistleblowers bear. It also acts as encouragement for others who see a problem to report it to the authorities.

Qui Tam Rewards in the Millions

Successful qui tam litigants often walk away from the courtroom with serious cash. How? The FCA gives individuals the right to share in financial settlements and awards from cases they initiate. In 2017, FCA lawsuits recovered more than $3.7 billion of taxpayer dollars. Relators, individuals who initiate the suits, can take home up to 30 percent of the winnings.

In a recent record-breaking win against Walgreens, for instance, the courts awarded 21 percent of the $60 million settlement to the whistleblower. The case highlighted a prescription billing scheme by which the pharmacy chain bilked federal and state healthcare programs out of millions of dollars by inflating the costs of prescription drugs.

That said, cases can last a long time. It’s not unheard of for a lawsuit to take years. There’s no guarantee the government will help your case, however. In fact, the U.S. government can not only refuse to assist, but it can also request the courts dismiss your case.

You can still forge ahead on your own and be successful. In 2017, cases where the government chose not to intervene brought in $425.7 million, and relators took home $43.6 million of the proceeds. It’s easier when the government gets involved — and much easier when they don’t try to fight your case!

There’s more than money involved in these fraud cases though. Individuals don’t raise an FCA lawsuit for a simple cash grab. You can see the real benefits the FCA in its origins.

Qui Tam Cases Help You Make the World a Better Place

The FCA is sometimes referred to as Lincoln’s Law. Out 16th president signed it into law in 1863. Congress passed the act in response to Civil War-related fraud against the government. Unscrupulous vendors promised to give our troops warm, durable clothes, sturdy shoes, and healthy meals, but they rarely delivered.

Similarly, today’s worst offenders aren’t just taking the money they don’t deserve. They’re hurting people in the process. In some cases, they’re killing them. Three examples from recent years truly demonstrate the consequences faced by victims of government fraud.

In the first, a company called Second Chance Body Armor was selling defective bullet-proof vests to law enforcement agencies across the country. The ruling determined their guilt and the federal government reimbursed the law enforcement groups for the purchased vests. For years Second Armor knew their products weren’t safe but continued to mislead agencies. Eventually, the scam led to the death of a police officer killed when a bullet went through his protective gear.

In another case, a dental management company settled for $23.9 million for their role in a Medicaid scheme in which dentists performed unnecessary root canals on baby teeth. Parents who rely on Medicaid can’t often afford to get a second opinion. The result? Thousands of children went through the pain and risk of dental surgery without any reason.

The largest Medicare fraud case of the century involved a group of 30 retirement homes throughout Florida. The owner paid hospital workers to refer thousands of patients who did not need in-patient care. He subjected patients to unnecessary procedures and used narcotics to keep them from speaking. Authorities say he fraudulently billed Medicare over $1 billion for their care. Not only did he abuse thousands of elderly people, by robbing Medicare he prevented others from getting the help they needed.

It took employees working with those companies to come forward to keep people safe. The financial rewards were fringe benefits. The payoffs involved in being a whistleblower often focus on the financial, but in reality, the results can go far beyond the bank account. Finding the right lawyer can help you maximize the results.

Find out more about the qui tam act and all of its benefits by contacting Bothwell Law Group online.

How a False Claims Settlement Makes Its Way Through the Courts

Posted on by Mike Bothwell

Getting a False Claims settlement is nice, but it often requires going through the court system.

False Claims SettlementThe False Claims Act is a powerful tool to stop fraud, but getting a False Claims settlement as a relator can be a very lengthy and involved process. This settlement usually comes as a result of someone going through the qui tam process. The purpose of this blog post is to explain what a qui tam case is and the major steps involved.

What Is a Qui Tam Action?

A qui tam action is a type of civil lawsuit where a relator (who is the whistleblower) sues someone or an organization that commits fraud against the federal government. The relator brings this lawsuit on behalf of the government and in return is eligible to receive a monetary award. This award varies but can range from anywhere from 15 percent to 30 percent of the money they can help recover. The exact percentage depends on how much work they provide in recovering the money for the federal government.

This percentage will drop if the relator takes part in the fraud. It might seem unfair that someone committing fraud can profit from it, but it is better that the federal government gets 85 cents on the dollar rather than zero cents on the dollar.

Getting an Attorney

If a whistleblower wants to become a relator, they must hire an attorney. This seems a bit odd since a criminal defendant facing decades behind bars can choose to represent themselves at the criminal trial. But the difference here is that in a qui tam action, the whistleblower is a relator, which means they bring a lawsuit on behalf of the federal government. Because it’s ultimately the federal government’s lawsuit, they decide on whether they want an attorney – and they always have an attorney.

So to bring a qui tam lawsuit as a relator, an individual must hire an attorney. The individual needs to hire a lawyer who has experience and knowledge in qui tam lawsuits. They are unlike any other civil or criminal court case, so a prospective relator doesn’t want an attorney to learn as the case goes along. They need experience right out of the gate.

Starting the Qui Tam Action

The qui tam lawsuit process officially begins when the relator files a complaint in federal court. The one unique thing about this complaint is that it is “under seal,” which means in secret. This means the defendant in the case has no idea it is now the defendant in a lawsuit. This secrecy is essential to prevent the defendant from hiding or destroying evidence or fleeing the country. It also helps protect the relator from potential retaliation because it allows them to stay anonymous.

Besides filing the complaint, the relator’s attorney will prepare a special memo for the United States Department of Justice explaining the fraud, as well as the evidence the relator has in support of the qui tam case.

The Federal Government’s Investigation

While the qui tam lawsuit is under seal, the Department of Justice will conduct its own investigation of the fraud. The Department of Justice initially has 60 days to complete its investigation. But since this is rarely enough time, they can easily get an extension. In most cases, it takes over 15 months for the DOJ to finish its investigation. Once the investigation is finally over, the Department of Justice will decide whether it will join the relator in the qui tam lawsuit.

The Federal Government’s Decision

The decision for the DOJ to join, or not join, can make or break the qui tam lawsuit. If the Department of Justice decides to join, it will litigate the case along with the relator. But if they choose not to participate, the relator may still proceed with his or her qui tam lawsuit.

If the Department of Justice decides to join the qui tam case, it can drastically increase the chances of success. One reason is due to the fact the DOJ has the resources of the entire federal government behind it. And there is a lot more money in Washington, DC than in any one person’s bank account.

If the Department of Justice decides not to join, that can create a problem because the relator loses out on two things. First, they no longer have the resources of the government to help them in the qui tam lawsuit. Second, it can embolden the defendant and encourage them to fight harder and not settle the case. This is because the Department of Justice will usually only decline to join when they think the case will lose.

One silver lining to the Department of Justice backing out is that if the relator wins the qui tam case, they are much more likely to receive a higher percentage of the money recovered for the federal government.

Qui Tam Litigation Takes Place

Now the case can proceed mostly like any other civil case. The defendant will receive a copy of the complaint. Discovery will take place. Then there is the trial. If the qui tam action settles, it will usually be during the litigation process and before the trial begins.

Interested in Speaking with a False Claims Act Attorney?

Click to find out more about a False Claims settlement by contacting our legal team at Bothwell Law Group online.