We specialize in health care fraud, including comprehensive handling of complex and large-scale healthcare fraud litigation, including qui tam actions brought pursuant to the California Insurance Frauds Prevention Act (California Insurance Code, § 1871.7).
If you have questions regarding Qui Tam litigation or the whistleblower process, please refer to the information below or our F.A.Q.s
If you are contacting us as a potential whistleblower or you beleive you have knowledge of healthcare fraud, please feel free to contact us here.
How Do Qui Tam Cases work?
Qui Tam litigation allows private individuals, or “whistleblowers” with knowlege of past or present fraud committed against the federal government to bring a suit on its behalf and receive a part of the penalty imposed. Qui Tam Lawsuits are intended for the purpose of helping whistleblowers stop several types of largescale fraud, including Medicare, Medicaid, Medi-Cal, etc, that impact the government financially and to recover the billions of dollars that have been fraudulently stolen from the United States treasure and taxpayers. Qui Tam litigation is predicated on United States and state specific “False Claims Acts” which allow people who are not affiliated with the government to file actions against entities allegedly partaking in fraudulent activities.
Overview of the Qui Tam Process
If an individual has evidence to suggest fraud against the government and decides, he/she may contact a firm to handle the potential suit. According to the False Claims Act, private persons, known as “relators”, may sue an individual or business that is or has defrauded the government and recover funds on the government’s behalf. Qui Tam lawsuits remain “under seal” to protect the entities involved while investigation is under way. Detailed documentation and comprehensive analysis are necessary to prove that an entity took part in healthcare fraud. Many times, the government investigates allegations of fraud with the help of the whistleblower’s attorney but whistleblowers also have the option of pursuing action without the government.
If defendants are found liable under the False Claims Act, they may pay up to three times the government’s losses plus any additional penalties for each false claim submitted.
False Claims Act
The False Claims Act was originally conceived during the Civil War. Originally known as “Lincoln Law”, the provision was enacted to curb fraud committed by companies and individuals who were defrauded the union army. For instance, war profiteers were sending boxes of sawdust instead of guns and profited tremendously. “Qui Tam” provisions were set up to incentivize and allow for private individuals to expose wrongdoers. In addition to the Federal False Claims Act (31 USC 3729-3733), there are individual state False Claims Acts, such as California Insurance Frauds Prevention Act (California Insurance Code, § 1871.7).
Types of Healthcare Fraud
There are several types of healthcare fraud including:
- Counterfeit or Fraudulent Medical Devices
- Off-label marketing and Improper Practices Regarding Pharmaceuticals
- Fraudulent Group Purchasing Organizations Practices/Kickbacks
- Services not rendered/add-on services
- False Coding / Upcoding
- Any type of “Kickback”
- False Certifications
- Lack of Medical Necessity
- Fraudulent Cost Reports
- Grant or Program Fraud
- Medicare Risk Adjustment Fraud
- Any other fraud that would fall under the False Claims Act