Qui Tam litigation is a complicated and specialized area of the law. Accordingly, all medical records and billing disputes I review are carefully screened to identify medical billing practices that may give rise to possible Qui Tam lawsuits. I can co-counsel actionable claims with qui tam counsel to determine how best to recover taxpayer monies lost to medical billing fraud against public health plans.

 

WHAT IS A QUI TAM LAWSUIT?  WHO IS A WHISTLEBLOWER UNDER THE LAW?

A Qui Tam lawsuit is special kind of lawsuit.  In the medical billing context, a Qui Tam lawsuit is filed in the Florida or Federal courts, where a private citizen (sometimes called a “whistleblower” or “relator”) sues a medical provider or similar individual or company as plaintiff, to recover money or funds the healthcare related defendant (individual or company) which that provider or company received from a state or federal government medical plan or program, through theft or fraud.

 

What are Bases for Qui Tam Lawsuits
Brought By Whistleblowers in Florida?

Qui Tam lawsuits have involved bill padding, overstated costs, substandard products, charges for products or services that weren’t provided, purchase of products or services for applications or uses contrary to regulatory approval, and cheating the government out of money in various other ways.  Medical billing fraud is perhaps the most common cause of qui tam litigation suits in recent years. The governmental health plans victimized by these fraudulent medical billing practices run the gamut from Medicare and Medicaid to state and even local medical programs and plans.

 

In its current form, the federal False Claims Act prohibits any “person” from “knowingly present[ing], or caus[ing] to be presented, to an officer or employee of the United States Government or a member of the Armed Forces of the United States a false or fraudulent claim for payment or approval.”  31 U.S.C. 3729(a)(1). The Act also prohibits a variety of related deceptive practices involving government funds and property, including via fraud against public health plans.

Whistleblowers and Fraud:
Suing Under the False Claims Act

The citizen (or “whistleblower”) brings the “Qui Tam” suit on behalf of the state or federal government for violation of a statute called the “False Claims Act.”   This statutory scheme dates back to Civil War times, and was passed to combat rampant fraud that existed in military contracts.  Similar laws exist on the state level as well, and the combination of federal and state laws are among the single most effective tools taxpayers have for exposing and combating fraud against the government.

Financial Recovery to the Whistleblower
Established in the False Claims Acts


Under both the Florida and the federal False Claims Acts, as well as those of other states, whistleblowers are entitled to share in any civil recovery achieved by the government based on the relator’s original material information.  Where the government intervenes in the case, the relator stands to receive between 15-25% of the civil recovery, and where the government declines intervention the relator can receive between 25-35% of the civil recovery.

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