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The Process for Lawsuits That Stem from the False Claims Act and Medicare

False Claims Act and Medicare

False Claims Act and MedicareLawsuits 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.

Does a Regular Court Make Judgements on Qui Tam Claims?

qui tam claims

qui tam claimsTo win qui tam claims filed under the False Claims Act, two conditions must be met. First, you have to file a lawsuit in federal court. Second, you have to win that lawsuit through trial, or a negotiated settlement. Easy, right?

Not so fast. While it does sound quite simple, there are several things to consider. We’ve broken down the court process for you below.

Qui Tam Claims: It’s All about Evidence

When bringing a qui tam case, the devil is in the details, or rather, the evidence. You need to provide your attorney with solid proof the business or individual in question was overcharging, submitting falsified claims, or otherwise getting more money from the government than it should. This is what determines whether someone has violated the False Claims Act, or not.

Paper trails, emails, receipts, vouchers, digital records and so forth are the best kind of evidence for supporting your claim. And in this instance, more is always better. Providing the who, what where, when and how will be key to securing a favorable outcome. You need enough to eliminate even a shadow of a doubt; and this is where an experienced attorney comes in.

Hiring a Qui Tam Attorney and Determining Whether You Have a Case

Once you’ve gathered the evidence, it’s best to take it to a qualified lawyer, familiar with the FCA and qui tam lawsuits. They’ll review all the information you’ve provided and help you determine if it’s enough to bring a civil lawsuit in the U.S. District Court where the fraud occurred.

Unfortunately, hearsay isn’t enough to file a complaint. Your attorney must have enough information to understand where and how your company receives government funds, as well as how the fraud was perpetrated, and how long it went on. They must also understand how you came to have this information, whether any of it has already been made public, and if you’ve already approached your employer about your findings.

Once they have the facts straight, they’ll determine whether to move on to filing stage.

Filing a Civil Lawsuit Under the False Claims Act

The facts you’ve assembled will form the basis of your written complaint; something known as a “Relator’s Statement”. These will then be forwarded to the Attorney General and the State’s Attorney when filed under seal (meaning no one but you, your lawyer and the government know you’ve filed suit) at the U.S. District Court.

These documents should contain everything needed to persuade the U.S. government to join, or intervene, in your case. The goal is to get the government to join you, and bring the weight of their investigative and legal services to bear in your case.

Note: It is imperative you keep the terms of the lawsuit under wraps. If it is made public, the judge will have grounds to dismiss your case, and you will have lost before a trial can even start.

The Government Investigates

When deciding to intervene in your case, the government will conduct a lengthy investigation into the allegations. This can take up to three years in the most extreme circumstances, although most if the time it’s much quicker. If the government joins, they will take over your case completely, and the Justice Department becomes responsible for trying (or settling) the case.

If they don’t join, you’re still allowed to bring suit on their behalf. This is when the seal period ends, and the defendant is finally served with the complaint. The lawsuit then continues along in almost the exact same manner as any other federal civil litigation.

Hiring the Right Qui Tam Attorney Is Essential to Success

You want someone with the experience and know-how to get the government on your side, and advise you about your best options. Call 770.643.1606 to find out more about qui tam claims by contacting Bothwell Law Group online.

Does Unnecessary Medical Billing Fall under the False Claims Act?

Unnecessary medical billing

When reading the False Claim Act, it may not seem perfectly clear whether unnecessary medical billing is covered by the law. The False Claims Act is a detailed law, covering multiple industries and various types of fraud. If you suspect a healthcare provider of committing fraud, there are a few things you should know before taking action under the False Claims Act.

What Is Unnecessary Medical Billing?

Unnecessary medical billing can take many forms. In some cases, a physician will bill for a service never provided or upcode a service as a more expensive test or procedure in order to obtain further compensation. In other cases, the healthcare provider will intentionally misdiagnose a patient, knowing this diagnosis will enable them to bill for costlier tests and procedures the patient never needed. Another example of unnecessary medical billing occurs when a patient is provided a service or supply they never needed because the healthcare provider is hoping to receive additional funds.

Not All Unnecessary Medical Billing Falls under the False Claims Act

All unnecessary medical billing is wrong, but not all unnecessary medical billing falls under the False Claims Act. This law was specifically created to allow for prosecution of entities which are misusing government funds. This means, any unnecessary medical billing being paid by Medicare or Medicaid will fall under the law. The False Claims Act allow for citizens to act on behalf on the behalf of U.S. government by filing a complaint.

This is compared to cases where a private insurance company is being billed unnecessarily. This type of insurance fraud is not covered under the False Claims Act, but it is illegal. The private insurance company will need to seek out an attorney who can work with them to file a lawsuit on their behalf.

Reporting Medicare or Medicaid Fraud

If you are the employee at an organization which receives reimbursement for services from Medicare or Medicaid and you suspect fraud is being committed, you can become a whistleblower. If you are a recipient of services being paid for through Medicare or Medicaid, you can also report fraud. Many people choose to report fraud through a hotline provider by the Attorney General in their state. However, if you wish to receive up to 25 percent of the recovered funds as a reward for filing a complaint, you must work with an attorney to file a claim.

An experienced whistleblower attorney will be able to guide you through each step of the process. They can make sure you are protected against retaliation for filing the complaint and they can help you take every possible step to increase your chance of receiving a portion of the recovered funds.

At Bothwell Law Group, we are experienced working with whistleblower lawsuits. To learn more about unnecessary medical billing and the False Claims Act, call 770.643.1606.

The Top False Claims Act Penalties of 2015

false claims act penalties

false claims act penaltiesLast year was a record year for False Claims Act penalties, and 2015 is pacing similarly so far. As the year draws to a close, it has become clear how seriously the government is dealing with organizations and corporations who involve themselves in fraudulent activity. In fact, in 2015, we saw two of the largest settlements under the False Claims Act—each one right around $500 million.

In the first six months of the year, approximately $1.96 in government funds was recovered from the healthcare, government contracts, and financial industry.

The Top False Claims Act Penalties of 2015

Daiichi Sankyo Inc., $39 Million Settlement

This global pharmaceutical company agreed to a $39 million False Claims Act settlement after a whistleblower revealed they had been paying kickbacks to physicians who agreed in advance to prescribe the drugs they produce. A part of the False Claims Act is the Anti-Kick Back Statute, which aims to avoid physicians’ recommendations being biased because they have received gifts, monetary or otherwise.

The whistleblower in this case, Kathy Fragoules, received $6.1 million as a reward for filing a complaint against her former employer, Daiichi Sankyo Inc.

Community Health Systems Professional Services Corporation (CHSPSC), $75 Million Settlement

Along with three affiliated hospital in New Mexico, Community Health Systems Professional Services Corporation (CHSPSC), agreed to a $75 million settlement after they were accused of making illegal donations to local governments. These donations were then used as part of the state’s Medicaid payments to the hospitals.

The whistleblower in this case, Robert Baker, was the former CHSPSC revenue manager and he received $18,671,561 as a reward for filing a complaint against his former employer.

DaVita Healthcare Partners, $495 Million Settlement

This national kidney dialysis company announced in May that it would be paying a $495 million settlement as the result of a False Claims Act lawsuit. DaVita was accused of throwing away good medication after billing Medicare for it and are believed to fraudulently received millions of dollars of government funds as a result.

The whistleblowers in this case, Dr. Alon J. Vainer and Nurse Daniel D. Barbir, who were both employed by DaVita, will receive a combined total of $135 million as a reward for filing a complaint against their employer.

Trinity Industries, $663 Million Judgement

This government contractor was order to pay approximately $663 million after a judge deemed them liable for government funds lost as a result of the company’s actions. In the lawsuit against the company, it was revealed that Trinity has made changes to the guardrails they manufacturer without notifying federal regulators.

The whistleblower in this case was a former competitor of the company and they will receive an estimated $200 million dollars as a reward for filing a complaint against Trinity Industries.

If you have reason to believe you have information about fraudulent activity that may lead to False Claim Act penalties, contact a False Claims Act attorney by calling 770.643.1606.

What are the Qui Tam Statute of Limitations?

Qui Tam Statute

Qui Tam StatuteQui Tam lawsuits are brought by private citizens on behalf of the federal government in instances of fraud by persons or corporations . Many of these cases involve health care fraud by pharmacies, hospitals or others for drugs or services through Medicare and Medicaid, both federal governmental programs. Both the federal government and the whistleblower benefit. And like all matters of litigation, statutes of limitations, limiting the time in which the suit may be brought, apply. Once the qui tam statute of limitations has expired the case cannot be brought.

Whistleblower lawsuits (or qui tam ) have become an integral part of the enforcement of the False Claims Act.

The statute of limitations for a qui tam action is found in Section 3731(b) of the False Claims Act. A civil action may not be brought more than six years after the date on which the alleged violation of the False Claims Act is committed, or more than three years after the date on which material facts giving rise to the cause of action are either known or reasonably should have been known, and in no event more than ten years after the violation of the Act.
If this appears confusing, it is. In essence, the second half of this provision tolls the qui tam statute of limitations, providing the government a longer period of time in which to file suit, an additional three years. The question is whether this tolling provision applies in situations in which a private person, or “relator,” or whistleblower brings the suit on behalf of the government. And on this question, the courts are split. In the majority of federal jurisdictions, the courts have ruled that the tolling provision does not apply to the whistleblower. However, there are jurisdictions in which the courts have applied the tolling statutes to the individual whistleblower, effectively extending the statute of limitations.
In addition, in these cases, there is always a question about the date that the violation occurs. Most courts have held that the violation occurs on the date that the false claim is submitted. Other jurisdictions have held that the statute starts to run when the claim is actually paid. This further complicates the issue of the statute of limitations.
Finally, there is a Wartime Suspension of Limitations Act that further tolls the statute of limitations when the United States is at war. Courts have applied this further tolling of the statute of limitations, ruling that the statute of limitations for whistleblower cases has been tolled since 2002 when Congress passed the Iraq War Resolution.
This is a complex area of law and an attorney’s help is needed to navigate the Qui Tam Statute of Limitations and how they are applied within any given jurisdiction.

Qui Tam Statute of Limitations: How Long Do I Have to File?

Qui Tam Statute of Limitations

Qui Tam Statute of LimitationsDo you have grounds for filling a false claim, but are you unsure of the qui tam statute of limitations? Understanding how long you have to file a qui tam lawsuit is important. Lawsuits filed outside of the statute of limitations cannot be pursued by the government and the relator, or the citizen bringing attention to the fraud, cannot be rewarded for exposing the fraudulent activity.

How long do I have to file a False Claims Act lawsuit?

In an effort to encourage citizens to disclose knowledge of fraud in a timely manner, a statute of limitations was built into the False Claims Act. The False Claims Act outlines the statute of limitations for qui tam lawsuits in section 3731(b). This section of the False Claims Act states that a suit can be filed up to 6 years after the occurrence of the fraudulent activity.

How does the Qui Tam statute of limitations apply to the government’s actions?

After outlining the statute of limitations and how it applies to relators of fraud, the False Claims Act also addresses the issue of how long the government has to take action in recovering money lost as the result of fraud. According to section 3731 of the False Claims Act, the United States government can take action up to three years after receiving information concerning the fraud or at the very most 10 years after the fraudulent activity occurred. While there has been some debate concerning whether this portion of the statute of limitations can be applied to relators, the general consensus is that this portion was created to govern the United States government’s actions in qui tam lawsuits.

What about first-to-file?

Outside the qui tam statute of limitations, there is another way the government is encouraging relators to file a qui tam lawsuit in a timely manner. In section 3730(b) of the False Claims Act, the first-to-file statute is outlined. Citizens can only be rewarded for disclosing knowledge of fraud if they are the first person to file information about a specific fraudulent activity. This section of the False Claims Act was created to encourage timely filing of a qui tam lawsuit but it was also created to prevent multiple lawsuits being filed concerning the same fraudulent activity.

Public knowledge of the fraud?

The Qui Tam statute of limitations and the first-to-file rule were created to encourage timely reporting of fraudulent activity. There is one more reason relators should act quickly and file a qui tam lawsuit in a timely manner. Similar to first-to-file, if the fraud is made public before filing, the relator is no longer entitled to compensation for disclosing information regarding the fraud.

At Bothwell Law Group, we focus all of our efforts on lawsuit related to the False Claims Act. Because of this, we are able to act quickly, filing qui tam lawsuits in a timely manner. If you have questions about the qui tam statute of limitations, click to contact the Bothwell Law Group today.

What Is the Difference Between Federal and State Whistleblower Laws?

State Whistleblower Laws

State Whistleblower LawsIf you want to blow the whistle on a fraudster who has been stealing money from your state’s government, understanding state whistleblower laws is vital before moving forward with a False Claims Act lawsuit. Even though state whistleblower laws are typically modeled after federal whistleblower laws, there are some important differences between the two.

Before moving forward with a false claims act lawsuit, understand the following facts about state whistleblower laws:

There are some states that do not model their state whistleblower laws after federal whistleblower laws.

Currently, there are a few states that only allow their citizens to file False Claims Act lawsuits if they are pertaining to healthcare fraud. For example, if an employee has knowledge that their healthcare employer is intentionally misfiling a Medicare claim, they can file a whistleblower lawsuit.

All states with False Claims laws have protections in place for whistleblowers.

If you are a whistleblower, you do not have to worry about retaliation. You are protected from harassment and firing and there are laws in place that give you the right to sue if you are the victim of retaliation.

To file a state False Claims lawsuit, the state itself must have suffered loss or damage.

If you want to file a lawsuit within a specific state, that state must have lost money as a result of fraud. This means you cannot file a federal lawsuit under your state’s whistleblower laws.

Some states allow whistleblowers to consolidate state and federal lawsuits.

If the federal government or other states have also lost money along with your state as the result of fraud, some states will allow you to create one lawsuit to blow the whistle on a nation-wide fraud.

State False Claims laws vary from state to state.

Even though many states model their laws after federal laws, there are variances from state to state in these laws. In some states there are additional laws or statues that make the process of filing a false claims lawsuit entirely different and more involved.

As you can see, there is a lot to understand about state whistleblower laws and how they differ from the federal whistleblower laws that are currently in place. Because of this, it is very important to seek out a false claims act attorney who is experienced working within your state on false claims lawsuits.

Attorneys with extensive knowledge of both state and federal whistleblower laws will guide you through the process of filing you suit and help you to avoid mistakes that could cost you the reward you deserve for blowing the whistle on a fraudster in your state.

The lawyers at Bothwell Law team focus solely on False Claim Act lawsuits and are experts in this highly specialized field. Call 770.643.1606 to find out more about state whistleblower laws by contacting Bothwell Law Group online.

How to Choose a False Claims Act Attorney

false claims act attorney

false claims act attorneyIf you want to file a whistleblower lawsuit, choosing the right false claims act attorney is an important part of the process. If you have knowledge of fraud being committed against the government, you can file a false claims, or qui tam, lawsuit.

As a citizen, the False Claims Act gives you the power to file false claims lawsuits on behalf of the government. Not only does the False Claims Act give you the right to sue a fraudster, it protects you from any possible retaliation that may result from the lawsuit. Additionally, the person who has filed the lawsuit may be rewarded if the government decides to pursue the case.

Don’t Choose Just Any False Claims Act Attorney

The false claims act attorney you choose could be the determining factor of your success in false claims court. Because the government could reward you up to 25 percent of the money recovered in the case, you want to choose an attorney who is experienced and equipped to handle your case. There are four things you should be looking for before hiring a false claims act attorney:

  1. Choose a False Claims Act attorney with experience.

    The False Claims Act is complicated, and there are many factors playing a role in the process of filing a qui tam lawsuit. The reward statue of the False Claims Act is especially complicated. Because of these, we suggest you hire an attorney who has extensive experience filing False Claims lawsuits.

  1. Choose a False Claims Act attorney with connections.

    False Claims lawsuits require extensive communication between the False Claims Act Attorney and the attorneys working with the government. Because of this, it is especially beneficial if the attorney you hire has already established strong relationships with these attorneys through previous work or lawsuits.

  1. Choose a False Claims Act attorney who is honest and straightforward.

    Only a portion of qui tam lawsuits are accepted by the government. The attorney you have chosen for your case should be knowledgeable enough to see if your case has a chance of being further pursued by the government. Additionally, your attorney should be honest with you about how strong your case is. Because of this, it is important you choose an attorney who has a reputation for being straightforward and honest with their clients.

  1. Choose a False Claims Act attorney who values open communication.

    A False Claims Act lawsuit can take as much as three years to complete. These lawsuits require extensive conversations between you and your attorney, as well as between your attorney and the attorneys working for the government on your case. Because of this, it is important to choose an attorney who communicates openly and reliably with you.

Bothwell Law Group attorneys have a combined 30 years of experiencing filing False Claims Act lawsuit. Contact our skilled false claims act attorneys at Bothwell Law Group by calling 770.643.1606 today.