Qui Tam
REWARD for Reporting Medicare & Medicaid Fraud
The government will pay you up to 25% of the amount it recovers
through the successful prosecution of Medicare and Medicaid fraud cases. Each
year the government losses millions of dollars due to fraud. The ultimate
victims of fraud against the government are the American taxpayers. The
government pays this “reward” because much of this abuse can’t be detected
without the help of health care workers and others who have inside information
about fraudulent activity.
Do you know any hospitals, health care businesses, HMOs, nursing homes, medical
clinics, labs, companies or individuals that have been involved in filing
fraudulent claims for Medicare or Medicaid?
Your help is needed to help maintain the integrity of our national health care
system. You are providing a great service to the government and American
taxpayers by reporting abuses. The government will reward you for your
assistance. Also, the law protects the jobs of persons who blow the whistle on
fraudulent activity.
About the Whistleblower (Qui Tam) Program
Qui tam is a provision of the Federal Civil False Claims Act that allows private
citizens (“relators”) to file a lawsuit in the name of the U.S. Government
against any entity or individual that receives or uses government funds as a
result of fraud. The relator shares in any money recovered by the government.
This unique law was enacted by Congress in order to effectively identify and
prosecute fraud against the government and recover revenue lost as a result of
the fraud.
Who Can File a Qui Tam Action?
Employees and Former Employees: An employee files a qui tam action based
on his or her direct knowledge of fraud on the part of their employer. Often it
is a former employee that files a claim. Usually, in these instances, the
employee was terminated or quit under duress as a result of trying to blow the
whistle internally.
Competitors: Another eligible relator is the competitor of the company
being charged or an employee of the competitor who has direct knowledge of the
fraud being committed.
Subcontractors: Companies or persons who subcontract with a government
contractor have filed qui tam actions against a contractor that commits fraud
against the government.
Federal Employees: Despite the court challenges, a recent federal appeals
court decision upheld the right of a federal employee to be a relator in a qui
tam action.
Relator’s Share of the Award
The relator's share is a minimum of 15 percent and a maximum of 30 percent of
the amount recovered by the government.
The size of the relator's share of the award depends on several factors:
1. If the Government joins the lawsuit and successfully prosecutes the case, the
relator can receive between 15 and 25 percent depending on the extent of the
relator's contribution to the case.
2. If the Government does not join and the relator successfully prosecutes the
case, the relator will receive between 25 and 30 percent of the proceeds.
3. If it is determined that the relator was involved in the wrongdoing, the
court can reduce the relator's share at its discretion depending on the
circumstances of the relator's involvement.
How large can settlements get?
Excerpts from a January 19, 2000 press release:
“WASHINGTON - Millions of Medicare beneficiaries and American taxpayers can
give thanks once again to private citizens who come forward with evidence of
wrongdoing against the federal government, according to Iowa Senator Chuck
Grassley.
The Justice Department unveiled its largest health care settlement in history
against a national chain of kidney dialysis centers. First tipped off by private
citizens who blew the whistle on allegations of fraudulent Medicare claims, the
federal government launched an investigation which resulted in a $486 million
settlement including criminal, civil, restitution and other penalties against a
German-owned medical company for bilking government health programs.
According to the Justice Department, the agreement with Massachusetts-based
National Medical Care, Inc., a kidney dialysis subsidiary of Fresenius Medical
Care North America, includes allegations that company officials charged Medicare
for hundreds of thousands of needless medical tests and lab procedures for
patients suffering from chronic kidney disease and paid illegal kick-backs to
obtain referrals of lab business.
The record-breaking $385 million civil settlement resolves six lawsuits brought
by seven private citizens under the whistleblower provisions of the False Claims
Act.
"The False Claims Act is the government's most effective tool against
fraud," said Grassley. "Today's announcement proves the merits of the
law beyond any reasonable doubt. I'm sure 39 million Medicare beneficiaries and
every American taxpayer would agree with me. We must not let up in our effort to
shut-down the bad actors, to safeguard the financial integrity of the Medicare
trust fund and to protect the hard-earned dollars that every worker in America
sends to Washington."
How to Bring A Qui Tam Action
To bring a qui tam action the relator must be the first to file a claim.
Therefore, if you have information concerning fraud on the government it is
important to act promptly. The attorneys at the law firm of Mulligan and
Banham will provide a confidential evaluation of your claim at no cost or
obligation. To contact an attorney call 619-238-8700.
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