Qui Tam :: Federal False Claims
QUI TAM refers to cases filed under the federal False Claims Act (or similar state statutes) by private citizens seeking to recover money for fraud on the U.S. government.
The federal False Claims Act allows private citizens - whistleblowers/relators - with knowledge of false claims and fraud to sue and recover damages and fines on behalf of the U.S. government for this fraud, and to monetarily participate in the recovery of the money for reporting and actively pursuing the the fraud.
The Federal False Claims Act is the tool used to fight, for example, health care fraud - Medicaid and Medicare fraud and defense contractor procurement fraud on the federal level.
In addition, many states have false claims acts that may also be used to recover money for fraud on the state government.
The federal False Claims Act was enacted to help and encourage individuals - whistleblowers or relators - to step up and report any type of fraud perpetrated on the federal government or a state government.
For example, one hypothetical area of fraud may fall under long-standing GSA contract guidelines in which companies that contract with the GSA are obliged to provide the government with favorable pricing for the items they sell to the government.
This is commonly referred to as the Best Price. Prior to the award of the contract, and during the course of the contract, government vendors must provide the government with complete and accurate information about the discounts that they offer to non-government commercial customers.
This information allows the government to negotiate its best price, and protect its most favored customer status. If a government contractor in a contract with the GSA does not give the government accurate and complete data about the discounts offered to commercial customers, and if it does not afford the government an opportunity to achieve its most favored customer status for products to be sold to eligible federal agencies, then Company A may be in violation of the Federal False Claims Act.
Almost unbelievable, but true, is the amount of money that the government is defrauded out of each year.
Incredibly, the citizens of the United States are defrauded out of billions (yes, billions with a “B”) and billions of dollars as a result of fraud committed against our federal government by unscrupulous individuals or companies.
Some of the more common areas of our governments agencies wrought with fraud include: the Department of Health and Human Services (health care) and the Department of Defense (defense contractors).
Some of the fraudulent activity may include:
- contractor falsifying test results on product cost of quality
- health care provider bills for unnecessary or not preformed
- grant recipient charges for costs not associated with the grant
- billing for goods or services never delivered
- billing for marketing, lobbying or other non-contract related corporate activities
- submitting false service records or samples to show better than actual performance
- presenting broken or untested equipment as good or operational
- performing inappropriate or unnecessary medical procedures to increase medicare reimbursement
- billing for work or test not performed
- billing for premium equipment when it is actually inferior equipment
- running multiple lab tests when the first test was sufficient and within range of parameters
- defective testing - certifying something as passing but actually it did not
- unbundling - using multiple codes instead of one code for drug panel tests to increase cost
- bundling - billing more for a panel of tests when one test is all that is needed
- double billing
- up-coding - inflating bills by using more expensive codes
- billing for branded drugs when a generic is provided instead
- upcoding employees work - billing doctor rates when nurse of resident did the work
- failing to report known product defects and continue to sell to government
- billing for research that was never conducted or falsifying research data paid by government
- winning contracts through kickbacks or bribes
- billing for unlicensed or unapproved drugs
- forging physician signatures that are required for medicare or medicaid reimbursement
- prescribing or treating in a certain way or regimen in order to gain favor with hospitals, labs or pharmaceutical companies
For example, Health care and procurement fraud cases constituted about 79 percent of all qui tam cases filed between 1987 - 2005 and the total amount of money recovered as a result of these qui tam cases was in excess of $15,000,000,000 dollars. Whistleblowers share of the money recovered between 1987 and 2005 was in excess of $1,600,000,000 dollars.
We are here to help you recover our government - federal or state - money from those unscrupulous individuals or companies that defraud our government.