Medicare Qui Tam Actions

If an individual has knowledge of Medicare fraud being committed by a licensed healthcare professional or entity, that person can bring a Medicare qui tam action against the provider. In qui tam actions, the individual whistleblower acts in the name of the government. They also share in the proceeds of any succesful settlement or judgment – with rewards that can be as high as 30%.

If your healthcare practice, group or facility is the target of a Medicare fraud qui tam action, the attorneys at Norman Spencer Law Group can help. Over our more than 10 years in the healthcare law arena, we have represented and defended many clients involved in civil, criminal and qui tam cases.

Medicare fraud Qui Tam actions can be started by any private individual, whether it’s a patient, coworker, colleague, or current or former employee. As long as the person has knowledge of a Medicare fraud or a false claim filed with the government, that person can file a Medicare fraud qui tam lawsuit.

The person filing the lawsuit is known as the “relator,” and relators stand in the shoes of the federal government during the qui tam action. The federal government also has the option of stepping in at any time, and frequently does so at a later date.

While anyone with knowledge of fraud or false claims can bring a Medicare fraud qui tam action against a healthcare professional or entity, that knowledge must meet certain criteria to be valid.

For instance, a relator is prohibited from bringing a qui tam action based on knowledge from official proceedings or public info unless the relator is the original source of the information. Relators are also prohibited from bringing a qui tam action against a healthcare professional or entity if a similar qui tam action against that professional or entity already exists.

Many Medicare qui tam actions are brought by healthcare professionals who have evidence of fraud against former or current employers. They are also frequently brought by healthcare providers who have evidence of fraud against suppliers and other healthcare professionals.

A number of violations can result in Medicare fraud qui tam actions. Some of the most common include:

• Fraudulent billing practices related to government programs, such as Medicare, Tricare or Medicaid
• Billing, upcoding or overbilling for services not provided
• Violations of anti-kickback statues and Stark laws by doctors, laboratories or pharmacies
• Inappropriate registry agreements
• Actions taken under the Medicare Incentive Reward Program

When a Medicare fraud qui tam action is filed, it is kept under seal for about 60 days. The relator sends a copy of the complaint to the civil division of the Department of Justice (DOJ), and the DOJ has 60 days to investigate and decide if it wishes to intervene.

A routine practice for the DOJ is to notify the court that it makes no decision regarding intervention, reserving its right to intervene at a later time. When the government does not intervene in a qui tam action, the relator can be rewared with up to 30% of the settlement or judgment. If the government decides to intervene, the relator is rewarded with a lower percentage.

Medicare fraud qui tam cases can be very costly and complex. They’re costly not only financially, but also for your reputation, your practice or organization, and your entire career. Qui tam whistleblower cases require the knowledge and skills of experienced attorneys that deal with complex federal laws associated with the False Claims Act. The legal team at Norman Spencer Law Group is at your service.

Our lawyers are extremely well-versed in abuse and fraud laws, inclusive of anti-kickback, false claims and Stark laws. We are able to handle the most complex Medicare qui tam cases, representing both defendants as well as healthcare professionals seeking to file qui tam actions.

In addition to defending clients that are the target of qui tam actions, the lawyers at Norman Spencer Law Group have strategies that can help prevent those actions from being filed in the first place.

Protecting your practice or organization is imperative, and an experienced qui tam attorney can help. Our legal team has helped clients review current practices and implement new ones that significantly reduce their risk of being targeted by a qui tam action.

Whether you’re the target of a qui tam action, want to protect your practice or have knowledge of fraud and want to file a whistleblower claim, our healthcare legal team can help. Contact the Medicare qui tam attorneys at Norman Spencer Law Group to schedule a consultation today.