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What Does a Health Care Qui Tam Attorney Need to Prove a Case?

health care qui tam attorney

health care qui tam attorneyA health care qui tam attorney needs a case that involves a direct party—usually an employee or former employee—bringing a case of fraud against the government. It’s a case filed under the False Claims Act, which was developed to protect the government against fraud. Many circumstances leading to fraud involve

Medicare or Medicaid, both of which are federally regulated programs to pay for medical services. Health care qui tam cases can also include nursing home fraud, pharmaceutical fraud, medical device fraud, hospice or home health fraud and healthcare scams.

Here are a few examples of health care fraud activities that might be involved:

  • Billing for services not provided
  • Billing for more expensive services than the ones performed
  • Delivering more expensive services than were medically needed
  • Misrepresenting the diagnosis to justify payment
  • Creating false documentation to support payment
  • Billing under the provider number of a different doctor than the one who performed the procedure
  • Performing medical procedures without a physician supervising
  • Backdating procedures for a time the patient was insured
  • Kickbacks and Stark Law violations
  • Billing for “overflow” of medicine
  • Off-label marketing of pharmaceuticals

You may wonder if the information you have is enough to file a health care qui tam case. While every case is individual, knowing the basics of what an attorney needs to prove a case could help you determine if you’re heading in the right direction.

It’s like packing for the family summer vacation. If you leave everything to memory and guesswork, you’ll likely forget something important. If you make a list of all the essentials, you stand a much better chance of getting to where you’re going with everything you need. You know that will save you time- and probably a whole lot of hassle and expense than if you just pack off the cuff.

Here are some things your health care qui tam attorney needs to prove a case:

Your Health Care Qui Tam Attorney Needs to Know the Timeframe

One of the first things to knock off your qui tam case checklist is when the fraudulent activities took place. There is a statute of limitations of six years in false claims acts. Some circumstances fall outside this boundary, but your attorney needs to know when the fraud took place.

Documentation of dates can be one of the most powerful pieces of evidence in a health care qui tam case. This record will serve to prove the timeframe is within the statute of limitations.

Your Health Care Qui Tam Attorney Needs to Have Credible Information of Fraud

You may be aware of fraudulent activity at your place of employment due to your expertise and experience. Your health care qui tam attorney will talk with you about the information you are aware of and help determine if it is credible enough to provide the basis of a case. This information may be verbal, or you may have physical evidence. Physical evidence is tricky and can be difficult to obtain. Talk with an attorney who is knowledgeable about false claim act suits and he or she will be able to determine the credibility of what you know.

When you meet with your health care qui tam attorney, bring any proof you have as evidence of the fraudulent act. Your evidence can include things like receipts, copies of fraudulent paperwork or bookwork and other items that may be in your possession. Your attorney will have a staff to investigate and gather evidence and will assist you in determining if that evidence is sufficient for a qui tam case.

Your Health Care Qui Tam Attorney Needs to Determine If You Are an Original Source

Only one person can bring a particular qui tam case. If the fraud has already come to the attention of the government, you cannot bring a separate case. Your attorney will research and find out if you are the original source of the alleged fraud. Your information comes from inside information, if you are the primary source, not from something you read about or heard about somewhere else.

Your Health Care Qui Tam Attorney Needs Knowledge to Prove a Case

It’s important to choose an attorney who knows qui tam law in the health care field. The details matter in any lawsuit and with qui tam cases there are an awful lot of rules and regulations governing every aspect of the process. Also, if the government chooses not to intervene, you need an attorney with the wisdom to know if you should proceed on your own or not. Choose an attorney who has successfully argued health care qui tam cases in the past, so you can trust he or she will make solid decisions.

Learn more about the benefits of using a health care qui tam attorney by contacting the Bothwell Law Group online.

What Is a Qui Tam Lawsuit and Are There Consequences for the Whistleblower?

What Is a Qui Tam Lawsuit

What Is a Qui Tam LawsuitIf you’re new to the medical industry, you may be wondering what a qui tam lawsuit actually is. Even if you’re an industry veteran, the term “qui tam” is not exactly intuitive, and you might be wondering who this Qui Tam person is. Keep reading for the details you need to know to get some clarification on this important topic.

What Is the False Claim Act, and Where Does Qui Tam Fit In?

The False Claim Act is a law protecting whistleblowers, and aimed at preventing and punishing anyone trying to defraud the government. Qui tam lawsuits are a particular type of civil lawsuit, covered under the FCA, which allow an individual or group to bring suit on behalf of the government.

The term “qui tam” is actually an abbreviation of the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur” – or – he who brings a case on behalf of our lord the King, as well as for himself. Perhaps you can see why “qui tam” is the shortened abbreviation?

Protection for Qui Tam Whistleblowers

Under the FCA, whistleblowers are explicitly protected from retaliation and discrimination. This protection begins right from the start, with lawsuits being filed under seal. In other words, only the person filing and the government are aware of the allegations and ongoing investigation.

Once filed, an anti-retaliation provision takes effect. This protects the person filing (also known as a relator) from things such as being fired, harassment or other negative job-related problems resulting from reporting the fraudulent activities to the government. Anyone found to be in violation of the retaliation provision can be liable for double damages, plus additional attorney fees. Damages can include both lost wages, as well as other harm suffered.

Rewards for Favorable Qui Tam Lawsuits

In the event the relator wins their case, they can be awarded as much as 30% of the recovery money. How large the award is will depend on a few factors.

Firstly, whether or not the government decides to intervene, or “join,” your case. Generally speaking, the government is conservative in their case selection for intervention. They make the decision based heavily on how well researched the case is at the start, as well as the size, scope, and impact of the lawsuit. However, this only happens in a small minority of cases. It also significantly increases the chances a court will find in your favor. As a result, your percentage of the award is capped at 25%. If the government chooses not to intervene, you can be awarded as much as 30% of funds.

The lucrative nature of qui tam lawsuits means most attorneys take the cases based on outcome. Put another way? Your out of pocket expenses are likely to be less than other civil lawsuits.

Wondering If Your Case Qualifies?

Contact Bothwell Law Group at 770.643.1606 to find out more about what a qui tam lawsuit is and if your case qualifies.