Philadelphia Qui Tam & Whistleblower Defense Attorneys

Representing Your Rights as a Whistleblower

The federal government and many state and local governments, including New Jersey and the City of Philadelphia, have so-called “False Claims Act” statutes that allows private citizens to be rewarded for exposing fraudulent activity against the government. Under the Federal False Claims Act, a whistleblower can bring a lawsuit on behalf of the government and receive a portion of the government’s recovery. The Federal False Claims Act also protects whistleblowers against retaliation.

This is known as “qui tam” litigation. “Qui tam” is the abbreviated term for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” meaning “[one] who sues in this matter for the king as well as for himself.” The person filing the qui tam litigation is often referred to as the “relator” or “whistleblower.”

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Qui tam lawsuits are highly sensitive in nature, and must be navigated with care and caution. For example, most False Claims Act statutes require the lawsuit to be filed under seal and in camera. Whistleblowers who fail to follow these rules may forfeit their right to share in the recovery.

At Sacks Weston, LLC, we are experienced in whistleblower and qui tam litigation. Our Philadelphia lawyers have obtained numerous recoveries under various False Claims Act statutes, and we can help guide you through the complicated litigation process.

Types of Fraud Claims in Qui Tam Lawsuits

Many people aren’t aware of the fraudulent acts that occur in most, if not all, industries. In the research community, for instance, fraud can occur when incorrect or false information is used in government-funded studies. In academia, misrepresentations by a school to obtain government funding is known as grant fraud.

The most common types of fraud occur in the healthcare industry and involve Medicare and Medicaid. Below are common violations:

False Claims Act (FCA) Violations: The Federal False Claims Act makes it illegal for an individual or organization to knowingly defraud the United States Government, such as by creating false records or filing false claims. A significant whistleblower law, the FCA allows private citizens to confidentially file qui tam suits, which are lawsuits on behalf of the government.

Anti-Kickback Statute (AKS) Violations: The Anti-Kickback Statute is a significant federal fraud and abuse statute that affects business relationships in the healthcare, pharmaceutical, and medical device industries. Specifically, it protects federal healthcare program beneficiaries from getting influenced by money or anything of value on referral decisions. Kickbacks can result in doctors providing products and services that are unnecessary, poor quality and expensive.

Stark Law Violations: Also known as the Physician Self-Referral Law, the Stark Law prohibits physicians from referring Medicare and Medicaid patients for designated health services to an entity in which physicians or their immediate family members have a financial relationship, direct or indirect.

Medicare and Medicaid Secondary Payer (MSP) Violations: In an effort to shift primary medical costs from Medicare and Medicaid to private sources of payment, like auto insurance and workers’ compensation programs, Congress enacted laws that designated Medicare and Medicaid as the payers of last resort. A violation may occur if a provider bills Medicare or Medicaid despite the existence of private coverage.

Medicare and Medicaid Fraud: Medical providers and patients alike are prohibited from filing fraudulent reimbursement claims. Among the most common instances of Medicare and Medicaid fraud are billing for unnecessary or unperformed procedures, medical tests or equipment in addition to forging receipts, overstating an insurance beneficiaries’ cost in paying claims and denying valid claims altogether.

Upcoding: Medical providers are prohibited from fraudulently charging medical bills. As such, upcoding occurs when a healthcare provider inputs false billing codes and subsequently charges Medicare or Medicaid for a costlier service than what was actually performed.

Unbundling and Billing Fraud: Unbundling occurs when medical providers submit multiple claims a single medical procedure. For example, a doctor orders one panel of blood testing to look for four compounds, but the laboratory conducts four individual tests instead of one single panel. The laboratory may have committed unbundling fraud.

Government Contract Fraud: State and federal governments depend on private companies to provide a range of goods and services. As such, they contract with private entities to execute specified tasks. However, when such companies don’t meet the standards and expectations outlined in their contracts, then they may be subject to government contractor fraud allegations. Examples of government contract fraud include:

  • Falsifying information on contract proposals
  • Billing for work that was never performed
  • Falsifying labor and material costs
  • Using substandard, unauthorized materials
  • Misrepresenting a project’s status in attempts to continue getting funding

Grant Fraud: State and federal governments distribute hundreds of billions of dollars every year to universities, local governments, organizations and individuals for certain uses and based on promises that such funds will be spent as intended. With this in mind, grant fraud occurs when such funds are misused or are obtained through deception, such as lying on applications.

IRS & Tax Fraud: A notorious offense that is highly prioritized by the IRS, tax fraud is an intentional attempt to avoid or cheat tax obligations. Examples include false exemptions or deductions, failing to pay taxes, forging or altering tax documents and failing to comply with tax laws. Tax fraud must been a certain monetary threshold to permit a whistleblower to share in recovery.

Speak with Our Philadelphia Litigation Lawyers

If you are concerned about the repercussions of your whistleblower actions, we encourage you to discuss your case with our firm. The government provides protections for whistleblowers because they want private citizens to come forward about fraudulent activity that costs the government and taxpayers’ money. As a whistleblower, you may be entitled to a financial award for your honesty and courage.

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