Whistleblower / Qui Tam

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A whistleblower (also known as a relator) is a private individual with knowledge of a fraudulent, corrupt, or unlawful scheme of a company, corporation, or organization that is intended to defraud a governmental program such as Medicare or Medicaid. Usually, a whistleblower is a current or former employee but could be an individual with insider information about an organization's illegal business practices. Under the federal False Claims Act, a whistleblower can sue on behalf of the government to recover civil penalties and damages.

A successful suit not only stops the dishonest conduct, but it also deters similar future conduct. In some cases, the government may decide to aid in the litigation. When a suit is successful, this may result in the whistleblower receiving a substantial share of the government’s recovery. If the government decides not to intervene, he or she may conduct the action unilaterally. In these cases, he or she would be entitled to a greater share of the amount of any judgment or settlement reached.

The government incentivizes these types of lawsuits because they do not have the time or resources to investigate and prosecute the governmental fraud. To remedy the government’s over taxation, there are Qui Tam lawsuits, which enable private citizens to bring claims for damages and receive a percentage of any recovered funds or penalties.

The attorneys at Shelby Roden have experience handling these types of lawsuits. Our attorneys were Plaintiffs’ counsel in the HealthSouth Corp. False Claims Act lawsuit, which ultimately settled for $325 million. HealthSouth was the largest provider of medical rehabilitation services in the United States. The lawsuit stemmed from allegations that from 1996 to 2002, HealthSouth routinely submitted Medicare claims without proper plans for patient care from physicians.

Fraudulent practices against government healthcare programs still frequently occur today. Examples of fraudulent practices include, but are not limited to, the following:

  • Submitting claims for healthcare goods and services that were not rendered;
  • Submitting claims for patients who do not exist or who subsequently never received the healthcare goods and services billed for in the claim;
  • Providing “kickbacks” for referrals paid for by governmental health insurance programs;
  • Up-coding claims to healthcare goods and services that were more expensive or serious than the goods or services actually provided;
  • Billing for healthcare goods and services that were not medically necessary; or
  • Investing and, simultaneously, referring to entities that provide certain health goods and services paid for by health insurance programs.

If you feel that you have witnessed fraud on a governmental program, our attorneys would like to speak with you. We understand many honest individuals may have reservations about reporting fraud for fear of losing their jobs. Fortunately, the False Claims Act shields individuals from retaliation and our firm will do everything in our power to ensure you are fully protected.