If you discover that a company is cheating the U.S. government, you should consult with a whistleblower attorney to see if you may be able to bring what is called a “qui tam” case. Whistleblowers reveal fraudulent activity that otherwise would not be brought to light.
The federal law that covers most of these cases is called the False Claims Act. Many states also have their own False Claims Acts. North Carolina has a False Claim Act, which applies if you find that someone is cheating our state out of taxpayer dollars. There are also federal and state laws that protect some whistleblowers who discover fraud on the job.
If you think that you have discovered fraud against the government, it is crucial that you call a whistleblower lawyer right away. The next steps you take are very important and sensitive and it’s important that you get it right. An experienced whistleblower attorney can tell you if you potentially have a case, and can talk with you about how to preserve the claim.
A whistleblower claims attorney will file a qui tam case “under seal” at first, so the public does not know about the case, and the whistleblower’s identity remains anonymous. The government will investigate the whistleblower’s claims. If the government finds that there was fraud committed, the government’s lawyers can decide whether to join in the lawsuit and pursue it individually. State whistleblower claims have a different procedure.
The penalties against people or businesses that commit fraud against the federal government are severe. Those who are found to have committed fraud will have to pay the government and the individual “treble,” or triple, damages plus attorneys’ fees and costs. As an incentive to bring the claims, the whistleblower typically recovers 15-25% of the total recovery as well as his or her attorney fees and costs for bringing the case.
A whistleblower claim exists anytime a person or business submits a false claim to the government in order to get a payment from the government. Most of the time the companies committing fraud do it on a grand scale. They submit fraudulent charges to the government over and over, so that even the smallest charges add up.
There is also private whistleblowing when an employee internally reports fraud, sexual harassment, sexual assault, corruption, discrimination, or other misconduct. Our whistleblower attorneys have represented and advised many clients who have reported misconduct internally to someone in their company. It is against the law to retaliate against someone for reporting sex, race, or religious discrimination in a company with more than 15 employees. It is also illegal to retaliate against someone who reported fraud in a company that is publicly traded. We help these individuals file a lawsuit if necessary and negotiate agreements with the employer to protect their reputations and prospects for future employment.
Qui tam, or “whistleblower,” lawsuits are a type of civil action brought under the Federal Claims Act whereby the whistleblower is rewarded monetarily for funds that are collected against those providers who have committed Medicaid or Medicare fraud, or wrongful billing practices. If an individual has evidence of fraud against any federal or state program and “blows the whistle,” that person is entitled to a portion of the recovery. However, such a whistleblower must take specific steps to ensure their share of the percentage of any recovery.
Medicaid is a state program that provides medical care benefits to low-income individuals. Medicare is the federal program that provides medical care benefits to the elderly and those with severe disabilities. Medicaid or Medicare fraud happens when a provider – which includes hospitals, labs, doctor’s offices, dentist’s offices, nursing homes, pharmacies, clinics, counselors, and home health care providers – knowingly makes or causes to be made a false or misleading statement or representation for the use of obtaining reimbursements through the Medicare or Medicaid programs. If a provider intentionally misrepresents the services rendered, often they may be subject to criminal and civil penalties. However, if they negligently misrepresent the service rendered they may be subject to civil recoupment actions by the state or federal government. Some types of Medicare and/or Medicaid fraud include billing for medical services that are not rendered by the provider, billing for medical services that are rendered but are “up-coded” so as to receive a higher reimbursement rate, billing for the same service more than once, or providing services that are not medically necessary and then billing Medicare/Medicaid for them.
Because healthcare costs continue to rise, healthcare professionals are facing increasing governmental scrutiny and regulation regarding unnecessary billing. Sometimes mistakes are made and therefore audits are often performed by federal and state governmental agencies to determine if a recoupment action could be brought against the healthcare provider. Private insurance companies are also aggressively pursuing the same recoupment actions.
It is important to speak with an experienced lawyer who has handles qui tam or whistleblower claims. The lawyers at Miller Law Group in Raleigh, North Carolina, have represented numerous whistleblowers and actions against those individuals and/or businesses that wrongly billed the government for services.
If you believe you have a whistleblower claim, contact Miller Law Group for a free consultation.