Qui Tam & Whistleblower Claims

Protecting Those Who Speak Up Against Fraud

Discovering fraud against the government can put you in a difficult position. You may have access to information that the public does not know, while also worrying about your career, professional reputation, financial security, or the consequences of coming forward.

You do not have to navigate that decision alone.

At the Law Offices of Schwartz & Arminavage, our attorneys represent whistleblowers in matters involving suspected fraud, false claims, and misuse of government funds. We help clients understand their rights, evaluate the information they possess, and determine whether a qui tam action or other whistleblower claim may be appropriate.

These cases can be legally and factually complex. They also require discretion. Our attorneys take the time to understand how the suspected misconduct occurred, who was involved, what evidence may exist, and how the applicable whistleblower laws may protect our client.

What Is a Qui Tam Lawsuit?

The federal False Claims Act allows private individuals with information about certain fraud against the federal government to bring a lawsuit on behalf of the United States. These lawsuits are known as “qui tam actions,” and the individual who brings the case is commonly called the “relator,” also frequently known as a whistleblower.

A qui tam case is different from an ordinary lawsuit. Although the whistleblower initiates the action, the underlying claim belongs to the government because the alleged fraud involves government money or property.

After a qui tam lawsuit is filed, the federal government is given an opportunity to investigate the allegations and determine how it will proceed.

If the action results in a recovery, an eligible whistleblower may receive a percentage of the proceeds under the False Claims Act.

What Conduct Can Violate the False Claims Act?

The False Claims Act reaches more than simply submitting an invoice containing information that is obviously false.

Depending on the circumstances, liability may arise when a person or company knowingly:

Submits or causes another person to submit a false or fraudulent claim for government payment;
Uses a false record or statement that is material to a false claim;
Conspires to violate certain provisions of the False Claims Act;
Improperly obtains or retains government money or property; or
Knowingly avoids or decreases an obligation to pay money owed to the government.

False Claims Act cases are highly fact-specific. A billing error, contractual disagreement, or regulatory violation does not automatically constitute fraud under the Act. Our attorneys carefully evaluate the conduct involved, the evidence available, and the relationship between the alleged misconduct and government funds.

Common Types of Qui Tam and Whistleblower Cases

Government funds flow through a wide range of industries and programs, which means False Claims Act cases can arise in many different contexts.

Potential qui tam matters may involve:

Medicare and Medicaid fraud;
Healthcare billing fraud;
Billing for services that were never provided;
Medically unnecessary services or procedures;
Improper coding or billing practices;
Kickback-related claims;
Pharmaceutical or medical-device matters;
Government procurement and contracting fraud;
Defense contractor fraud;
False certifications involving government contracts;
Education or grant fraud;
Research and federal grant funding;
Government benefits fraud;
Improper retention of government overpayments; and
Other schemes involving false claims for government money.

The important question is not simply whether wrongdoing occurred, but whether the conduct potentially falls within the requirements of the False Claims Act or another applicable whistleblower law.

Healthcare Fraud and False Claims

Healthcare has historically been a significant area of False Claims Act enforcement.

Doctors, nurses, medical coders, billing professionals, administrators, executives, sales representatives, contractors, and others working within healthcare organizations may encounter practices that raise concerns about claims submitted to Medicare, Medicaid, or other government-funded healthcare programs.

Potential cases may involve billing for services that were not performed, misrepresenting services to obtain higher reimbursement, billing for medically unnecessary procedures, kickback arrangements, or other conduct that results in false claims for government payment.

Healthcare regulations are complicated, however, and not every billing or compliance problem constitutes a False Claims Act violation. A careful review of the facts is necessary before determining whether conduct may support a qui tam action.

Government Contractor Fraud

Private companies receive substantial government funding through contracts for goods and services. When a contractor knowingly misrepresents its performance, costs, compliance, or entitlement to payment, the conduct may potentially implicate the False Claims Act.

Cases can involve allegations concerning false invoices, overbilling, defective products, misrepresented costs, failure to provide contracted goods or services, or false certifications concerning compliance with requirements that are material to government payment.

Employees, former employees, subcontractors, competitors, and others with firsthand knowledge may sometimes be in a position to identify misconduct that government agencies would otherwise have difficulty detecting.

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Whistleblower Awards & Retaliation

Whistleblower Awards

One feature of the False Claims Act is its financial incentive for individuals who help expose fraud against the government.

When the government intervenes, and a qui tam action produces a recovery, the False Claims Act generally provides an eligible relator with 15% to 25% of the proceeds, depending in part on the relator's contribution to the case.

When the government does not proceed with the action and the relator successfully pursues it, the statutory share is generally 25% to 30%, subject to the limitations and circumstances provided by law.

The amount of a potential award depends on the facts of the case, the whistleblower's role, and the applicable statutory provisions. No particular recovery or whistleblower award can be guaranteed.

Protection Against Whistleblower Retaliation

Fear of retaliation is one of the most significant concerns many whistleblowers have about coming forward.

The False Claims Act contains protections for employees, contractors, and agents who experience retaliation because of certain lawful actions taken in furtherance of a False Claims Act case or other efforts to stop violations of the Act.

Prohibited retaliation may include conduct such as:

Termination;
Demotion;
Suspension;
Threats;
Harassment; or
Other discrimination in the terms and conditions of employment.

Depending on the circumstances, an individual who establishes unlawful retaliation may be entitled to remedies designed to make that person whole. Potential relief under the federal False Claims Act can include reinstatement, twice the amount of back pay, interest, certain special damages, litigation costs, and reasonable attorneys' fees.

Other federal or state whistleblower protections may also apply depending on the industry, employer, conduct reported, and circumstances surrounding the retaliation.

What If I Still Work for the Company?

You do not necessarily have to wait until you leave your employer to speak with an attorney about suspected fraud.

In fact, obtaining legal advice before taking significant action can be particularly important. Issues involving company documents, confidentiality obligations, internal reporting, communications with coworkers, and preservation of evidence can become complicated.

An attorney can help you understand the legal considerations involved before you decide how to proceed.

What If I Have Already Been Fired or Retaliated Against?

If you believe you were terminated, demoted, harassed, threatened, suspended, or otherwise retaliated against because you attempted to stop or report suspected fraud, additional claims may be available.

Retaliation claims can involve separate deadlines and legal requirements. Speaking with an attorney promptly can help preserve your ability to evaluate those rights.

Confidentiality Matters

We understand that whistleblowers may be particularly concerned about confidentiality.

The federal False Claims Act's seal requirement provides confidentiality during the initial stage of a qui tam lawsuit while the government investigates. However, the seal is not necessarily permanent, and individuals considering becoming whistleblowers should understand the potential implications before proceeding.

We work with clients to discuss those considerations and approach sensitive information carefully throughout the process.

Nationwide Qui Tam and Whistleblower Representation

Federal False Claims Act cases are not limited to one state.

The Law Offices of Schwartz & Arminavage can evaluate qui tam and federal whistleblower matters involving individuals and businesses throughout the United States. Because these cases arise under federal law and frequently involve federal agencies and programs, they often require counsel who understands the specialized procedures governing False Claims Act litigation.

State false claims and whistleblower laws may also apply in some circumstances, particularly when state government funds are involved. When appropriate, we evaluate those potential claims as part of the overall matter and can work with local counsel when necessary.

Speak With Our Qui Tam & Whistleblower Attorneys

If you have information about potential fraud involving government funds or believe you have experienced retaliation for reporting misconduct, our attorneys can help you understand your options. Contact the Law Offices of Schwartz & Arminavage to discuss your situation confidentially.