Yes. Under the Federal Civil False Claims Act (31 U.S.C., Section 3729), private citizens act on behalf of the Federal or State Government to bring an action against government contractors or any company who acts fraudulently with government funds. Under the False Claims Act, a qui tam lawsuit entitles individuals employed by the entity guilty of fraud to bring a lawsuit for fraud-related damages against the offending company.
Fraud Is Rampant In The Nursing Home Industry
Many nursing homes and medical service providers have turned to illegal practices to boost their bottom line. By some accounts, up to 10% of Medicare charges have some some type of fraud. Examples of fraud-related qui tam cases in the nursing home setting include:
Ghost billing- billing for patients that do not exist
Using inferior medicine or medical equipment, yet billing the government for the premium services
Billing more than once for the same service
Billing for services not performed
Offering free items or services in exchange for a Medicare or Medicaid number
Waiving co-payments routinely
Someone other than the physician completing the Certificate of Medical Necessity
Qui Tam Lawsuits Can Be Lucrative To Those Who Report Fraud
The government recognizes that fraud in the medical field leads increased costs and inefficiency. Further, the government realizes that they have the best chance of discovering medical fraud by providing a financial incentive to those who witness illegal acts.
If you uncover a situation where you believe the government is being defrauded, whistleblowers have the right to recover between 15 and 30 percent of the total amount recovered from the fraud lawsuit. The damages related to qui tam lawsuit can be substantial as the party initiating the lawsuit can sue for triple the amount of actual fraud damages plus civil penalties ranging between $5,500 to $11,000 per claim.
For example, if a nursing home charged Medicare $50 per physical therapy sessions for 1,000 sessions, it never provided to residents, the potential damages under a qui tam theory could be $11,150,000 ($50 x 1,000 = $50,000 x 3 = $150,000 + 1,000 x $11,000). In this case, the whistleblowing employee could be entitled to $3,345,000.
In the year 2003 alone the amount of U.S. recoveries in qui tam cases totaled 7.8 billion, with whistleblowers recovering a total of 1.3 billion. If you suspect any person, company or entity involved in defrauding the government, you should contact an experienced qui tam lawyer.
Lastly, qui tam cases require you to act quickly. In many situations only the first individual to file a claim will have a right to compensation.
Examples Of Related Recoveries:
$155,000,000 Medco Health
$26,000,000 Key West Pharmacy