Qui Tam Lawyers

< Whistleblower Law

Qui Tam Attorneys

In most civil cases, a plaintiff must demonstrate how they were personally affected by the harm caused by the defendant in order to file a lawsuit. However, the Qui Tam provisions found in False Claims Acts, including federal and state laws, provide a unique exception to this requirement. These provisions allow individuals to bring a lawsuit on behalf of the government, showing that the government was harmed and stepping into the government’s shoes.

This distinguishes a Qui Tam case from other civil cases because the individual is not only suing for themselves or reporting a violation to the government, but they are actually pursuing a legal claim on behalf of the government in court.

Due to the distinct nature of Qui Tam cases, they involve specific procedures and substantive issues that require special attention. Having a Qui Tam lawyer can be highly beneficial in navigating both the substance and procedural aspects of cases brought by individuals on behalf of the government. If you are interested in learning more about this legal area, reach out to a local attorney for further guidance.

Reward Laws

There are several whistleblower reward programs in existence, including the Securities and Exchange Commission’s (SEC) whistleblower reward program, the Commodity Futures Trading Commission’s (CFTC) whistleblower program, and the IRS’s whistleblower office. These programs were established as a result of the Dodd-Frank financial reforms.

These programs are significant as they have specific regulations that enable individuals to provide information to these agencies and potentially receive a reward if the government takes action based on that information. However, it’s important to note that these programs differ from full Qui Tam statutes, as they do not grant individuals an independent right to file a lawsuit for fraud. Nonetheless, they do offer certain anti-retaliation provisions, which can be crucial for whistleblowers.

Government Collection Entitlement

The federal False Claims Act underwent a significant amendment in 1986, effectively restoring its modern version. The current whistleblower award percentage ranges from 15% to 30%. If the government accepts the case and intervenes, the whistleblower is eligible for a reward ranging from 15% to 25% of the funds recovered by the government.

In cases where the government chooses not to intervene and the whistleblower proceeds under Qui Tam provisions, successfully litigating the case, the whistleblower can receive an award of 25% to 30% of the amount collected on behalf of the government. Around 30 states have their own False Claims Acts, many of which include Qui Tam provisions and similar award structures. While the exact percentages may vary slightly, the fundamental purpose of Qui Tam provisions remains the same: granting individuals the right to sue on behalf of the government.

Government Involvement

After the initial filing of the case, the government will assume control of the investigation into the whistleblower’s allegations. This investigation period can span several years. During this time, the government will thoroughly review the evidence provided by the whistleblower, conduct interviews, and gather additional information.

Throughout the investigation, the government may reach out to the whistleblower and their attorney for clarification, additional leads, or assistance in substantiating the allegations. They may also seek the whistleblower’s and their attorney’s insights on relevant laws and regulations pertaining to the industry in question. The government may have follow-up questions for the whistleblower on various aspects of the case.

Although the whistleblower is not in charge of the investigation and must adhere to the court’s seal, they can still play a crucial role in assisting the government’s investigation and facilitating recovery against the defendant. This collaboration serves as the basis for the whistleblower to be eligible for an award under the Qui Tam provision, which aligns with the intended purpose of reward incentives.

Government Case Review

Government officials typically assess the merits of a case when deciding whether or not to pursue it. During the investigation, they may uncover facts that the whistleblower was unaware of, which could affect the viability of the case. There are various reasons why the government may choose not to intervene. They have broad discretion in this regard and may decline to pursue a case if there are no significant damages involved or if there is no substantial public policy issue at stake. However, they also have the authority to proceed with the case.

In certain sectors like healthcare, if the whistleblower can provide evidence of kickbacks, illegal referrals, or violations of anti-kickback statutes or laws such as the STARK law, these violations could undermine the government’s obligation to pay for related medical claims. Consequently, if the government can substantiate such allegations, it is more likely to move forward with the case compared to other types of cases.

Pursuit-Worthy Cases

In cases where there is a third-party beneficiary involved, such as an individual receiving a healthcare service paid for by the government, the government is often more motivated to investigate allegations of fraud and has a better ability to establish damages. Since the government is responsible for paying for these services, it may not have the means to verify the nature of the services provided to the third party. Consequently, if fraudulent activities occur, the government may only become aware of it after paying the bill, such as illegal referrals, kickbacks, or defective drugs.

This situation places the government in a favorable position to pursue the case since it has paid for services based on misrepresentations made to it.

In the past, Qui Tam case law had a strict prohibition against cases where the government had knowledge of the fraud. However, that is no longer the case. While there is no direct prohibition against bringing a case when the government is aware of the fraud, it generally becomes more challenging to pursue such cases when the government has more knowledge about the fraud.

The realm of healthcare, including TRICARE, Medicare, Medicaid, state healthcare plans, and government employee healthcare plans, often involves situations where the government is not aware of problems that could indicate fraud. These types of cases, relatively speaking, are easier to prove, bring forward, and substantiate compared to other types of cases.

There are specific cases that present favorable opportunities for the government to pursue fraud, such as certain small business loans. These loans are intended to support small businesses, but fraudulent individuals may misrepresent themselves as minority or small business owners in order to obtain these government loans. In some instances, grant awards may also fall into this category of cases.

These types of cases differ from straightforward government contracts where a contractor provides a service to the government. Although these cases can be complex, they also have the potential for success.

Statutes of Limitations

Similar to other laws, the False Claims Act has statutes of limitations that apply to the underlying fraud and the anti-retaliation provisions. These limitations are generally straightforward, but there is one aspect that stands out.

Under federal law, there is a “right of repose” provision that can extend the statute of limitations for underlying fraud up to 10 years in certain circumstances when the federal government was unaware of the fraud for three years. Typically, the statute of limitations for fraud under the act is six years. In addition, whistleblowers have a separate three-year timeframe to sue for their own damages if they have faced retaliation.

Another unique aspect is that Qui Tam rights require the case to be filed under seal. This allows the government to review and investigate the allegations before making a decision on whether to intervene in the case.

Retaliation Suits

Individuals who have faced retaliation for being whistleblowers have the right to sue under many laws, which is a crucial protection. However, it is important to note that this right is distinct from the ability to sue on behalf of the government, which is the essence of the Qui Tam procedure.

The Qui Tam procedure grants individuals the significant right to bring a case and defend the interests of the government. This right is essential for individuals to safeguard the government and pursue legal action. Consequently, there are specific procedures involved in filing a Qui Tam action, including the use of distinct terms. Plaintiffs in Qui Tam actions are often referred to as “relators,” “plaintiff-relators,” or “Qui Tam relators,” all of which describe the individuals who initiate the case.

How We Can Help

During the period of the case being under seal, which can last for multiple years, the government carries out its investigation into the allegations made by the Qui Tam plaintiff-relator.

This prolonged duration, while the case remains confidential and the plaintiff-relator awaits the government’s findings regarding their complaint, can be challenging for everyone involved. Therefore, it is essential for the client and their Qui Tam attorney to collaborate closely and maintain open communication regarding the progress of the case.

These cases often involve complex sets of facts that the plaintiff-relator has accumulated over an extended period. It is crucial for the attorney and client to work together effectively, as extracting the case’s specific details from the individual’s knowledge takes time. Both the Qui Tam attorney and client must focus on the facts that substantiate the allegations of fraud against the United States.