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"Examples of Qui Tam Cases"
"Examples of False Claims Act Cases"
Attorney McInnis moderates legal panel on "Litigating Medical Necessity False Claims Act Cases" in Washington, D.C. at the 17th Annual Taxpayer's Against Fraud (TAF) Conference on November 3, 2017.
What is a Qui Tam lawsuit? Whistleblower
Attorney McInnis explains
A substantial part of our practice as Whistleblower Attorneys is representing ordinary people (known as relators) in qui tam actions under federal and state False Claims Acts.
A qui tam action is simply a lawsuit that a private person files in the name of the federal and/or a state and local government which typically alleges that the government is a
victim of some type of fraudulent scheme. If the qui tam lawsuit is successful and the defendant ends up paying money back to the government, then the qui tam relator gets a
percentage of those proceeds (known as the relator's share). This financial reward is for alerting the government to a difficult-to-detect fraud by starting the qui tam lawsuit,
and, in many cases, for assisting the government in its investigation and litigation of the whistleblower's allegations. Also, regardless of the outcome of the qui tam action,
the relator is protected from retaliation by his or her employer for engaging in covered whistleblowing activities. We do not charge an hourly fee for serving as qui tam lawyers,
but only get paid a contingency fee from the relator's share when the qui tam case is successful and/or from any money our clients recovers as damages for unlawful
whistleblower retaliation in the workplace.
Why are so many qui tam cases related to healthcare? It all comes down to money, says Healthcare Fraud Attorney McInnis
A lot of people wonder why so many of the reported qui tam whistleblower cases involve fraud against the Medicare, Medicaid and other government healthcare insurance programs.
Not wanting to sound cynical, but it's similar to what Willie Sutton answered when asked why he robbed banks (Because that's where the money is.), explains Healthcare Fraud Attorney
McInnis. Healthcare is one of the biggest categories of government expenditures, so it's only natural that it would be subject to large amounts of program fraud. While healthcare
false claims schemes may take many forms (billing for services never rendered, upcoding diagnoses and procedures, filing duplicate claims, failing to comply with CMS regulations,
and so on) and occur at different types of healthcare providers (hospitals, doctor practice groups, pharmaceutical companies and medical device manufacturers), the one thing they
all have in common is that some person or some organization submits an invoice or other type of claim to the Government asking to get paid for providing a service or product when
the claimant (or people involved in the transaction) knows the claimant is not entitled to receive the requested amount. Thus, in order to get paid from the government healthcare
programs, someone has to misrepresent, lie about or cover up important facts which render the claims for reimbursement as false or fraudulent. Filing a qui tam whistleblower suit
under the federal or states false claims act is one way to alert the government about such false and fraudulent healthcare billing activity, and in many cases, to help recover money
on behalf of the American taxpayers