Know Your Rights Under the False Claims Act

By: Josh Borsellino Josh Borsellino

Most nonlawyers are not aware that there is a federal statute that provides job protection as well as a potential substantial monetary reward for whistleblowers who report fraud against the federal government. Fraud against the government is unfortunately rampant. According to some studies, as much as 10 percent of Medicare charges that are submitted to the government are fraudulent. The two most common sources of qui tam lawsuits are in the medical and defense contractor industries. Some examples of fraud are:

  • Billing more than once for the same service
  • Charging for services not performed
  • Charging more than the standard rate for services or goods
  • Offering free items or services in exchange for a Medicare or Medicaid number
  • Billing for expensive goods and only providing less-expensive goods
  • Performing medical goods or services that are not medically necessary

The Civil False Claims Act, also known as the Qui Tam Statute, 31 U.S.C. Section 3729 et seq., allows a private individual to sue a person or company who is knowingly submitting false bills to the federal government. The False Claims Act also prohibits an employer from harassing or retaliating against an employee for attempting to uncover or report fraud against the federal government. If retaliation does occur, the relator may be awarded “all relief necessary to make the employee whole,” including reinstatement, two times the amount of back pay, litigation costs and attorney fees. More than 2,400 qui tam suits have been filed since 1986. The government has recovered over $2 billion as a result of the suits, of which almost $340 million has been paid to relators/whistleblowers. If the whistleblower’s suit is successful, he or she may receive from 15–30 percent of the government’s total recovery.

Texas has its own whistleblower law that may provide additional remedies to those who report Medicaid fraud. If you would like Bailey and Galyen to consider handling your potential qui tam case, please contact us at 817.276.6000.

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