Office workers in the pharmaceutical industry, employees of companies that do business with the government - and more and more frequently today billing professionals, nurses or other healthcare workers - may notice anomalies or excesses in bills sent to the United States government. Medicaid and Medicare provide substantial sums of money as reimbursement to hospitals, doctor's offices, clinics and other healthcare resources each year.
As we have discussed in February, the health care industry leads all sectors in fraud claims under the federal False Claims Act. In general, it is workers who bring evidence of fraud to light in these types of issues. The False Claims Act dates back to the Civil War when the government grew concerned about receiving shoddy products from entrepreneurs. The False Claims Act was created to root out fraud in government contracts.
Understanding Qui Tam Claims under the False Claims Act
Pursuing a claim under the False Claims Act is complex. People who bring these lawsuits act as a sort of "private attorney general" on behalf of the government. If you have already browsed the internet looking for information about these types of lawsuits, you likely have run across the phrase, "Qui Tam Lawsuit."
Qui tam is a shortened form of a Latin phrase that in its entirety essentially means that the whistleblower is bringing the lawsuit on behalf of the government (the Latin phrase refers to the King, which predates the laws under the U.S. Constitution), as well as for himself or herself.
The FSA law allows individuals in the private sector to file a lawsuit on behalf of the government to recover taxpayer money. Individuals, who are frequently referred to as "whistleblowers" are given an incentive to bringing the information forward.
The whistleblower is entitled to receive a percentage of any settlement or verdict for damages that results from the case. Moreover, whistleblowers are given job protection under the law. It is unlawful for an employer to retaliate against an employee for raising concerns about fraudulent billing practices in government contracts.