This is a powerful law that promotes the recruitment of “Whistleblowers” because it allows an individual under the False Claims Act to bring actions against any person(s) or organization that is fraudulently billing the federal government. A major source area for filing under this act and recovering damages involves the mammoth health care market. This act provides incentives by granting between 15% and 25% of any settlement award. This allows any individual or group of concerned persons who feel that there is evidence of financial deceit and unscrupulous activity between any health care entity such as a hospital, medical group, insurance company, product manufacture or related ancillary organization and the government in regard to, primarily, medicaid, medicare and tricare, as examples, to bring a lawsuit. These cases of misconduct and corruption are extremely expensive to pursue usually reaching exorbitantly high levels of cost so, it is critically important for the government to step-in and pursue the investigation and litigation. The Department of Justice in conjunction with the U.S.Attorney for the district in which the suit was filed have the option to intervene if convinced about the worthiness of the prosecution.
I have extensive experience in evaluating and filing these type of lawsuits. The facts must be substantiated enough to secure federal interest in expanding the investigation and the case must be presented in a very cogent, legally compelling manner that includes all pertinent, supporting federal statutes, regulations and laws to ensure it is picked up by the government.
This is an avenue for any responsible and ethical physician or other medical personnel who becomes so outraged at witnessing fraud that the pursuit of justice becomes a singular goal. Regrettably, with decreasing reimbursements in the future, one can expect an increased trend by some to use fraudulent and deceptive means to improve their bottom line in the health care arena.
If you find it necessary to become a “Whistleblower”, send me all your facts, suspicions and accusations and I will thoroughly review them. Sometime, after the initial contact, it maybe necessary to gather additional relevant information. My office will advise you as to the best course of action required to seek a Qui Tam case assuming your complaints meet appropriate federal guidelines and jurisdictional parameters.