A qui tam case in healthcare is one of the fastest growing claims in the last few decades, even surpassing military claims. Healthcare qui tam claims generally stem from improper or false billing for services or procedures, ‘off-label’ usage of FDA approved medications, or use of someone else’s health information to claim benefits.
Qui Tam Healthcare Cases and Whistleblower Laws?
Like any other qui tam cases, healthcare claims are covered by whistleblower laws. In a qui tam case, a person can raise a complaint on behalf of the government against individuals or companies that are behaving fraudulently. Once a suit is raised, the government can investigate the whistleblower’s claims and choose to join the suit; if the suit is successful, the whistleblower (or relator) may receive a reward of up to 25 percent of the funds recovered by the government in the suit.
To protect a whistleblower from retaliation by an employer or others named in the suit, qui tam laws provide up to double the damages, plus attorney fees, for any retaliatory actions taken against a whistleblower.
How Are Qui Tam Cases Verified?
A qui tam case is not as simple as seeing an attorney and signing an affidavit. There are a number of steps you need to fulfill in order to file a valid qui tam suit:
- You need to have credible evidence of wrongdoing committed by an individual or a company. The evidence needs to show either harm to the government, violation of the securities and commodities laws, or harm to employees or the general public.
- You need concrete evidence of wrongdoing. Documentary evidence, while not required, will vastly increase the chance of government interest.
- You need original evidence that cannot be gleaned from other sources. Evidence taken from public sources like the internet, TV news, or pubic government records cannot be used in a whistleblower claim.
- You need to file right away. Under the ‘first to file’ rule, a whistleblower cannot file a claim if another whistleblower has filed one using the same evidence.
- You need to remember the statute of limitations. It varies depending on the industry, but can range from 30 days to 6 years after the violations.
Can you Fake a Qui Tam Claim?
As with any suit, there may be unscrupulous folks who try to bring false claims under the False Claims Act. This usually happens in order to collect rewards under the qui tam provision. These false claims will not hold up under scrutiny, nor will the evidence bear them out. Be aware that you may also be liable for perjury should you lie under oath.
Have questions about a qui tam case in healthcare? Call the Bothwell Law Group at (770) 643-1606.
When to report fraud is a question you may be facing if you are aware of it happening but aren’t directly involved. If you don’t report it, will you be in trouble? There are a lot of unknowns in the world of whistleblowing and fraud. It’s time to dig into it for some insight and to give you direction and peace of mind.
If you’re wondering how to report healthcare fraud, you’re probably already in an uncomfortable position. Someone you work for (or with) is doing something illegal to defraud the government and the healthcare system it supports. You’ve found out, and now you think you need to do something about it.
The False Claim Act for healthcare is essentially a small component of a much larger set of regulations making it a crime to knowingly record or file a false claim, regarding any federal healthcare program. While Medicare and Medicaid are both considered federally funded programs, it also extends coverage to any plan or program providing health benefits (including through insurance) which receives any funding from the federal government or state-sponsored healthcare system.