Qui tam litigation hit record highs in 2022 and is now creating an industry of attorneys who specialize in the very complex qui tam cases.

A qui tam case is vastly different from a medical malpractice lawsuit. In a medical malpractice lawsuit, the plaintiff alleges they were injured by the defective practice of medicine. The suit requires an injury. A qui tam lawsuit alleges that fraudulent billing or treatment practices have robbed a government program of much-needed capital and the defendant should repay the debt with interest.  Qui tam relators or whistleblowers typically use the services of a law firm like Trombley & Hanes to piece together the claim and prepare a civil qui tam lawsuit.  If successful, the whistleblower stands to make money through a percentage of the total money recovered.  Most of the money is paid to the federal government as the victim of the theft in the first instance.

Last year alone, more than $2.2 billion dollars was recovered from various defendants in qui tam lawsuits. Meanwhile, Florida boasted some of the most serious cases of medical fraud anywhere in the country with losses from one defendant alone nearly reaching $1 billion.

COVID-related fraud 

Whistleblower complaints ticked up over COVID as more service providers sought to cash in on the fear. This created a situation where bad actors stole millions in healthcare reimbursements while the government was focused on the pandemic. The situation grew worse as more patients sought telemedicine services that are more difficult to track than in-person services. Further, new programs and policies went into effect that created a greater surface area for general types of fraud.

In the Fall of 2022, the U.S. government put out a special fraud alert detailing the scope of the problem. By then, recoveries under the False Claims Act already exceeded $2 billion. Those aren’t losses, folks. That number is what the government was able to recover. Losses may be as high as 10 times that amount.

Top allegations in qui tam lawsuits 

Today, false billing remains one of the most likely allegations a medical health clinic will have to defend. While some of these actors are abusing the system, harming public interests, and driving up the cost of health care for everyone, others get caught in the crossfire of a government that is over-vigilant about prosecuting fraud. Today, there is so much suspicion over billing that an honest mistake can turn into a qui tam allegation.

Defending a qui tam lawsuit 

Like all allegations of fraud, you cannot “accidentally” commit the sort of fraud that finds its way into a qui tam case. However, the standard of proof in all civil cases is lower than the standard of proof in a criminal case. That means it’s harder to defend and if the scales tip against you, you could find yourself owing a lot of money.

For that reason, you want an attorney with experience who understands the costs involved in bringing a qui tam lawsuit and can discourage the effort early with the right arguments. If not, you’ll have to defend the case before a jury.

Either way, Trumbley & Hanes offers top-quality representation to clinics and doctors accused of fraudulent billing under the False Claims Act. Call our Tampa criminal lawyers today to schedule a consultation and learn more about how we can help.