Qui tam lawsuits are civil lawsuits that make a complaint of a false claim or fraud against a person or entity receiving federal or state funds. If the person or entity is liable, the whistleblower can recover a percentage of the recovery with the bulk of the recovery going to the federal program who was defrauded in the first instance.
Alternatively, the government has the option of litigating the case on their own. This is especially useful when the claim is very large and complex and expensive to litigate. The government, with its unlimited resources, can oftentimes be in a better position to see the case through a final conclusion.
How does a qui tam lawsuit work?
A whistleblower would provide evidence of fraudulent billing practices or unnecessary medical treatment. Qui tam lawsuits can be filed against a number of professional service providers. However, most of these lawsuits involve healthcare companies. Some of these companies operate unscrupulously and the qui tam system allows the government to step back while simultaneously holding the bad actor accountable.
Qui tam lawsuits from the perspective of plaintiffs
From the perspective of the plaintiff, a qui tam lawsuit begins with a suspicion or discovery of fraud. The victim of the fraud is usually Medicare, Medicaid, or other private insurance companies. Most laypeople aren’t necessarily qualified to know if a test is unnecessary and if they’re on Medicaid, they probably don’t have access to billing information. So, often, you need an employee to come forward to a law firm like Trombley & Hanes to blow the whistle.
The law firm will then decide whether it will file the lawsuit under seal to protect the identity of the plaintiff. The government can intervene in the lawsuit whenever they want. The decision to intervene is based on the economy of investigations and whether or not the government thinks the matter is egregious enough to pursue.
If successful, the defendant will have to pay damages to the government and a portion of that would be given to the plaintiff as an award. The award is typically between 15% and 30% of the amount recovered.
Losing a qui tam lawsuit
If a health care service provider loses a qui tam lawsuit, their reputation as a medical services provider will be forever damaged. Further, they will owe money to the government for fraudulent billing and criminal charges may be filed against individual actors within the company. On the other hand, for an attorney to pick up the case, it has to be worth the concerted effort of filing a qui tam lawsuit.
Talk to a Qui Tam Defense Lawyer Today
Trombley & Hanes represents the interests of those facing qui tam lawsuits or medical fraud charges. Call our Tampa criminal lawyers today to schedule an appointment and we can discuss the allegations more thoroughly.