Lawsuits stemming from the False Claims Act and Medicare fraud are unique. They follow an entirely different process than normal civil litigation, and it’s important to understand the key differences before filing suit. Because the process is so distinct, you need to have a firm understanding of the ins and outs; otherwise, your suit could be over before it’s even begun.
Here’s a simplified breakdown of how the process works, and how you should proceed as you determine whether or not to file suit:
Gather the Evidence about Medicare Fraud, but Keep Quiet
This might seem like a no-brainer, but hearsay isn’t enough of a reason to go to court. Before you do anything rash, determine whether you have a way to prove your allegations. Needless to say, the stronger your evidence, the more likely you are to receive a favorable judgment or settlement. Anything in writing or in the form of digital files is your best bet: emails, receipts, paper reports, sales records, and so forth.
It’s also critical that you don’t tell anyone about your suspicions, or your possible lawsuit. We’ll explain more about why in a later section, but it’s best to stay mum on your findings until you….
Hire a Lawyer Who’s Got Medicare Fraud Law Experience
You’ll want to interview a few lawyers before settling on the right one. However, you should be looking for someone with a few key characteristics:
- Experience winning cases comparable to yours
- They’re straight-forward; they won’t promise you’ll win, but they will tell you the odds and how you can improve them
- They’ll listen to your goals; if you don’t want to drag out a trial for years, they’ll tell you your options and be willing to adjust their strategy accordingly
Once you have the lawyer, next comes the hard part.
Deciding Whether or Not to File a Qui Tam Suit
There are a lot of things to consider when determining whether or not to press forward with a qui tam lawsuit. Various job, personal and social ramifications are unprotected by the law, and you need to decide if filing this lawsuit is going to be worth it. If you hired an experienced lawyer in the previous step, he or she should be willing to lay these out for you in detail.
If you decide to press forward, this is when you…
File the Fraud Complaint Under Seal
“Under Seal” is a fancy way of saying “in secret.” You and your legal team will file with the Court, who, in turn, alerts the government. The government will then review your materials and launch an investigation. This part is critical; your employer will not be aware they are being investigated. This is precisely the reason we told you to keep your suspicions to yourself early on. If anyone violates the under seal order, it could cause the lawsuit to be thrown out.
The Government Makes a Decision on Whether or Not to Intervene
Based on the size of the prize and the strength of the evidence, the government will determine whether to intervene, or join your case. In other words, they decide if they want to take it over on their own, or let you carry it forward on their behalf.
If they join you, your odds of winning a favorable ruling or settlement go up significantly. However, your portion of the recovery will top out around 20%.
If they don’t join you, you can still carry the suit forward on your own. Depending on your case, you may still have a very strong chance of a favorable outcome. What’s more? Your portion of the recovery can be as much as 30%; a result of the inherent risk you’re taking by going it alone.
The Outcome of False Claims Act and Medicare Lawsuits
Either your case will go to court, or the company you sued will opt for an out-of-court settlement. Either way, you’ve made it to the end of the road, and a portion of the funds is now yours!
Still have questions about the False Claims Act and Medicare fraud lawsuits? Call 770.643.1606 to contact the Bothwell Law Group online.