Qui Tam Lawsuits

Qui Tam Healthcare Lawsuit Attorneys

We Represent Whistleblowers

With healthcare expenditures reaching an astronomical $2.9 trillion in 2013, it’s alarming to recognize that nearly ten percent, or roughly $120 billion, of government Medicaid and Medicare spending is lost to fraud and abuse each year. The ripple effect of such fraudulent activities in the Medicaid/Medicare sector is profound and far-reaching. Qui tam lawsuits emerge as powerful tools in holding wrongdoers accountable and mitigating these healthcare frauds.

Di Pietro Partners are experienced healthcare lawyers with extensive trial experience; furthermore, we understand the complex nature of healthcare law. Therefore, if you or someone you know witnessed medicare or medicaid fraud, our law firm can protect your interests and guide you through this process. 

What is Qui Tam?

Qui tam lawsuits are legal actions in which a private individual acting as whistleblower, sues on behalf of the government to recover funds that have been obtained through fraud or other illicit activities against the government. The term “qui tam” is derived from a longer Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which means “he who sues for the king as well as for himself.”

Understanding the False Claims Act

The False Claims Act (31 U.S.C. §§ 3729-3733) authorizes individuals to file lawsuits against entities or persons believed to have defrauded the U.S. government. Often referred to as “Qui Tam” actions, these lawsuits empower ordinary citizens, acting as “Relators,” to bring alleged wrongdoers to justice. Some state and local jurisdictions have parallel laws allowing for similar actions on their behalf.

The individual who brings forth such a claim is known as a “whistleblower.” While many whistleblowers are employees of the alleged fraudulent company, the Act doesn’t restrict the filing party to employees. Anyone with credible information, be it patients, subcontractors, or even competitors, can initiate a qui tam action.

When a whistleblower files under the False Claims Act, they might receive a share of the recovered funds, typically ranging from 15% to 30%. All claims filed are first presented discreetly to the government, shielded from the public eye. This confidential status, known as being “under seal,” ensures even the accused remains unaware of the ongoing investigation.

Upon receiving the claim, the Attorney General has a 60-day window, extendable upon request, to decide the government’s role in the litigation. If the government opts to intervene, they take the reins, collaborating with the whistleblower and their counsel.

Navigating a Declined Qui Tam Action

Should the government decline participation, the whistleblower, with their attorney’s assistance, has the green light to proceed independently. If you’re contemplating filing a claim, especially against an employer, it’s reassuring to know the False Claims Act shields whistleblowers from workplace retaliation.

Potential whistleblowers should act swiftly. The presented information must be fresh and not public knowledge, unless the whistleblower is the primary source. Moreover, the first individual to highlight a specific fraudulent activity via a qui tam lawsuit has exclusive rights to do so. And remember, there’s a ticking clock: the Act typically has a statute of limitations, often six years. Don’t hesitate.


Qui Tam’s Roots

Derived from the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” qui tam translates to “he who sues for the king as well as for himself.” This mechanism, allowing private individuals to sue on the state’s behalf, has roots in medieval England. However, in the context of the U.S., it became prominently associated with the False Claims Act (FCA) during the Civil War. As war suppliers took advantage of the chaotic situation, overcharging and underdelivering, the FCA was instituted to curb these fraudulent practices. Now, it has evolved into a critical defense against deceit in any government-funded program.

How Does Qui Tam Work in Practice?

The sequence of a qui tam lawsuit is quite distinct:

  1. Initiation: An insider, privy to some form of deceit against the government, acts as a whistleblower or “relator.” This individual then files a lawsuit under the FCA.
  2. Under the Seal: This step is pivotal for confidentiality. Upon filing, the lawsuit remains “under seal” (or secret) for 60 days. This window allows the government to probe the allegations without public or defendant knowledge.
  3. Government’s Choice: After investigations, the government may decide to “intervene” or join the lawsuit. If it opts out, the whistleblower can proceed independently.
  4. Outcome and Rewards: Successful qui tam lawsuits result in financial penalties for the offending parties. The whistleblower, for their pivotal role, is entitled to a fraction of the recuperated funds, typically ranging from 15% to 30% depending on various factors, including whether the government intervened.

The Importance of Qui Tam Lawsuits

Qui tam actions are not just legal procedures; they’re linchpins of transparency and accountability:

  • Public Fund Protection: They help recover funds that might otherwise be siphoned off through fraudulent activities.
  • Whistleblower Empowerment: By providing potential monetary rewards and whistleblower protections, qui tam actions encourage those in-the-know to step forward.
  • Deterrent Effect: The mere potential of a qui tam action can deter businesses from attempting to defraud the government.

Challenges and Considerations

Of course, like all legal mechanisms, qui tam lawsuits are not without complexities. There’s ongoing debate regarding the motivations behind such suits. While many are genuine attempts to rectify wrongs, there’s potential for misuse given the financial incentives. Additionally, companies can face significant reputational and financial repercussions, even if the claims against them prove unfounded.

In Conclusion

Qui tam lawsuits are a testament to the U.S. legal system’s adaptability and its commitment to marrying ancient legal traditions with modern needs. By empowering citizens to act on behalf of the collective good, qui tam actions remind us that the pursuit of justice often begins with a single voice, brave enough to speak the truth.