Medicare Qui Tam & Whistleblower Actions

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If You Have a Healthcare Whistleblower Claim to Pursue as a Relator, or Need to Defend as a Practitioner, We Are Here

What is a Qui Tam Action?

A Medicare Qui Tam action is when an individual sues or prosecutes for Medicare fraud (false claims) in the name of the government. The individual then shares in the proceeds of any successful litigation or settlement  sometimes as much as 30%.

Who Can Bring a Medicare Fraud Qui Tam Action?

Any private individual with knowledge of Medicare fraud or a false claim made to the government may bring a Medicare Qui Tam action.

A person bringing a Qui Tam action is called a “Relator.” The relator stands in the shoes of the federal government when bringing a Medicare fraud Qui Tam action. 

What are Stipulations of a Medicare Fraud Qui Tam Action?

A relator may not bring a false claims act action based on public information or information from official proceedings unless the relator is the original source of the information. Furthere, a relator may not bring an action where a private individual has raised a similar Medicare fraud Qui Tam action.

A Medicare Qui Tam lawsuit are generally brought by healthcare workers/providers (such as an office staff member or a nurse) who have evidence of fraud against an employer or former employer (such as the main physician of a health care practice). Cases are also commonly brought against suppliers and other providers whom the provider/relator has knowledge of the fraud.

What Are Some of the Types of Medicare Qui Tam Actions?

  • Fraudulently billing Medicare, Medicaid or Tricare
  • Overbilling, upcoding, billing for procedures not provided
  • Violations of Stark and the Anti-Kickback Statute by a doctor, pharmacy, laboratory, suppliers, or related
  • Improper registry agreements
  • Recovery under the Medicare Incentive Reward Program

How Can Government Intervene in a Medicare Qui Tam Action?

A Medicare fraud Qui Tam action is filed under seal for approximately 60 days. The relator serves the Department of Justice Civil Division (“DOJ”) with a copy of the complaint. The DOJ has 60 days to investigate the case and determine whether it wishes to intervene. Routinely, the DOJ will notify the court that it makes no decision on intervention, reserving the right to intervene later.

If the government does not intervene, a relator can earn up to 30% of the judgment or settlement. If the government does choose to intervene, the relator will earn a lower percentage of the recovery.

How Can the National Healthcare Attorneys at Chapman Law Group Help?

Medicare fraud Qui Tam Whistleblower cases are often very complex. They require the skill of an attorney who frequently deals with the complex federal laws pertaining to the False Claims Act. 

At Chapman Law Group, our unique skillset in both government investigations and healthcare defense law gives us the edge you need, whether as a relator wanting to pursue an action and needing a lawyer, or as a healthcare practice that is being investigated for Medicare fraud.

Our team of national attorneys includes a former Medicare prosecutor who, in his many years of handling claims against providers on behalf of Medicare, has become exceptionally knowledgeable in fraud and abuse laws. In addition, we have an ex-Medicaid prosecutor who is well-seasoned in prosecuting fraud claims against healthcare providers.

If you feel that you have a Medicare fraud Whistleblower claim, or if you or your medical practice have been named in a Medicare Qui Tam action, the national healthcare lawyers at Chapman Law Group are here for you. 

Our offices are in Detroit (where we serve Dearborn, Troy, Ann Arbor and Grand Rapids, and the rest of Michigan); Miami and Sarasota, Florida (for Jacksonville, Tampa, Orlando, West Palm Beach, and all of Florida); Los Angeles/Southern California; and Chicago. Contact us today.

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