Understanding Qui Tam Law and Whistleblower Protections
Financial misconduct and misuse of government funds cost taxpayers billions each year. Qui tam laws were passed to encourage whistleblowers to speak up when they witness fraud, such as overbilling Medicare or misusing federal funds. These cases involve a highly specific area of whistleblower law, and it’s important to have attorneys with direct experience handling them. At Wenzel Fenton Cabassa, P.A., we draw from that experience to advocate for whistleblowers, helping them understand their rights and navigate the legal process with clarity and confidence.
What is Qui Tam Law?
Qui tam comes from Latin: “qui tam pro domino rege quam pro se ipso in hac parte sequitur.” The rough translation of this phrase is “he who brings an action for the king as well as for himself.” A whistleblower aware of fraud can expose the fraud to help the government recoup those illegally taken funds and, if successful, can be rewarded.
A whistleblower qui tam lawsuit is brought under the False Claims Act. This legislation covers a wide array of fraud and abuse, including:
- Medicaid Fraud
- Medicare Fraud
- Trade Agreement Act (TAA) cases — violations in government contracts
- Best Price cases — price manipulation; claims for overcharging government entities
- Defense Contractor Fraud
- Off-label Marketing cases —unlawful marketing of pharmaceuticals
- Charging the government for work that was completed with substandard parts or not completed properly
What is a Qui Tam Attorney, and What Do They Do?
A qui tam attorney, also known as a whistleblower lawyer, specializes in representing individuals who have inside knowledge of fraud committed against the government. Their primary role is to help whistleblowers navigate the complex legal process and ensure that their rights are protected.
Qui tam attorneys have extensive knowledge of the False Claims Act, Qui Tam, and other relevant laws, including state whistleblower protection laws. They also have experience with qui tam investigations, litigation, and negotiations to help whistleblowers achieve successful outcomes.
The False Claims Act and Qui Tam Law
Fraud and abuse have been going on in the United States for a very long time. It goes back to the Civil War, with rampant issues on both sides. During the Lincoln administration in 1863, Congress passed the False Claims Act to help stop and combat fraud and abuse.
The federal False Claims Act, modernized in 1986, has proven to be the most effective antifraud law in the United States. It is an “American federal law that imposes liability on persons and companies (typically federal contractors) who defraud governmental programs.”
Protections for Whistleblowers
Under the anti-retaliation provisions of the False Claims Act, whistleblowers have job protection. This includes people considering filing a claim or individuals who decide to file a Qui Tam claim. However, it is not uncommon for retaliation to occur, so contacting a qui tam lawyer is recommended before an individual “blows the whistle.”
The types of retaliation a whistleblower may face include:
- Getting terminated from your job
- Getting a reduction in pay
- Losing regularly scheduled hours
If the whistleblower has faced retaliation, they can work with a qui tam lawyer to file a claim against their employer.
Potential Challenges in Qui Tam Cases
Qui tam cases can be complex and challenging. There are many steps involved in the process, and a lot of evidence to gather and present. This is where an experienced qui tam lawyer comes into play.
Some of the potential challenges that may arise in a qui tam case include:
- The statute of limitations: Qui Tam lawsuits must be filed within six years of the fraud being committed or three years from its discovery (with some exceptions). This means that whistleblowers have limited time to file their claims.
- Proving knowledge: For a successful qui tam lawsuit, the whistleblower must prove that the defendant knew they were making false claims to the government or acted with reckless disregard for whether their actions were fraudulent.
- The burden of proof: Whistleblowers must present sufficient evidence to prove the case, as the burden of proof is on them. This can be a daunting task without the guidance and support of a qui tam lawyer.
- Confidentiality: Qui tam lawsuits are filed under seal, meaning they are kept confidential while being investigated by the government. This can make it difficult for whistleblowers to discuss their cases with anyone other than their legal team.
- Possible Retaliation: As previously mentioned, whistleblowers may face retaliation from their employer after filing a qui tam lawsuit.
The challenges in qui tam cases highlight the importance of having a knowledgeable and experienced qui tam lawyer.
Types of False Claims Cases
Whistleblowers can file qui tam lawsuits for a variety of false claims cases, including:
- Health care fraud: This includes overbilling Medicare or Medicaid, billing for services not rendered, and providing unnecessary medical procedures.
- Defense contractor fraud: This involves contractors submitting false claims to the government for products or services that do not meet contract requirements.
- Grant fraud: This occurs when individuals or organizations misuse grant funds for personal gain instead of their intended purpose.
- Education fraud: This includes fraudulent activities by schools and universities related to student loans and financial aid programs.
- Procurement fraud: This occurs when companies misrepresent themselves in order to win government contracts.
These are just a few examples of false claims cases that can be brought under the False Claims Act. If you suspect fraudulent activity in any government-funded program, you must speak with a qui tam lawyer as soon as possible to discuss your options.
Medicare Fraud and Medicaid Fraud
Medicare and Medicaid are two of the biggest forms of government fraud. Medicare and Medicaid are government-funded health insurance programs designed to provide healthcare coverage to specific individuals, including the elderly, people with disabilities, and low-income individuals. Unfortunately, these programs are often targeted by fraudulent activities.
Medicare fraud occurs when healthcare providers or suppliers submit false claims to Medicare for services or products that were not provided or were unnecessary. This could include billing for more expensive procedures than what was performed, falsifying medical records, or providing referral kickbacks.
Similarly, Medicaid fraud involves submitting false claims to the Medicaid program for reimbursement. This may also include a variety of schemes such as billing for services not rendered, double-billing, and inflating charges.
Medicaid fraud can also occur when providers fail to meet the standards of care required by Medicaid.
Whistleblowers who know about Medicare or Medicaid fraud can file a qui tam lawsuit under the False Claims Act. These types of cases are complex and require experienced legal representation.
Privacy Protections for Whistleblowers
Qui tam law contains measures for the privacy of whistleblowers. Once a qui tam lawyer is secured and the legal claim is filed, your case is sealed for 60 days.
Your case is kept secret from the defendant accused in the fraud case throughout the time it is sealed. The only individuals and entities who know about the case are you, your lawyer, and the government.
While the case is sealed, an investigation is conducted. Qui tam cases, such as Medicare fraud, Medicaid fraud, and others, can be complex. So, it is common for the courts to grant an extension beyond 60 days. This gives the government the time to investigate and determine if it wants to join (intervene) in the case. Interventions in qui tam cases are infrequent.
Important note: State or federal governments will often ask the courts to partially lift the seal on a qui tam case to open it up for discussions and potential negotiations for a settlement.
How to Find the Right Qui Tam Lawyer
Finding the right qui tam lawyer to represent you in your case is essential. This individual should have experience and knowledge in handling qui tam lawsuits and a track record of success.
Here are some tips for finding the right qui tam lawyer:
- Do your research: Look for lawyers with experience in qui tam cases and a good reputation in this area of law.
- Schedule Case Evaluation: Meet with potential lawyers to discuss their experience, approach, and fees. This will give you an idea of whether they are the right fit for you and your case.
- Ask about their success rate: Ask about their success rate in previous qui tam cases and their experience negotiating settlements.
- Ask them about their resources: It is essential to have a lawyer who has the resources to handle your case effectively, including the ability to conduct thorough investigations and gather evidence.
When choosing a qui tam lawyer, it is essential to remember that not all lawyers have experience in this specific area of law. Therefore, it is crucial to research and find a lawyer with the expertise and resources to handle your case successfully.
Call Today for a Case Evaluation with A Qui Tam Lawyer
At Wenzel Fenton Cabassa, P.A., we stand by your side every step, offering unwavering support and expert guidance throughout your case. We understand the sensitivity and complexity of qui tam claims and ensure your rights are protected as we navigate this challenging process together. Backed by extensive experience in whistleblower laws, our attorneys are deeply committed to pursuing justice on your behalf.
As skilled negotiators, we work tirelessly for our clients. If a fair resolution cannot be reached, we are fully prepared to take your case to trial, fighting relentlessly to defend your rights in court. Our mission is to provide you with confidence and reassurance at every stage of the journey.
Contact us today for a confidential case evaluation. Let us deliver the legal skills and personalized attention you deserve.
Please Note: At the time this article was written, the information contained within it was current based on the prevailing law at the time. Laws and precedents are subject to change, so this information may not be up to date. Always speak with a law firm regarding any legal situation to get the most current information available.
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