Medicare Qui Tam & Whistleblower Actions

What is a Medicare Qui Tam Action?

A Medicare Qui Tam action is when an individual sues or prosecutes for Medicare fraud in the name of the Government and shares in the proceeds of any successful litigation or settlement – sometimes as much as 30%.

Who Can Bring a Medicare Fraud Qui Tam Action

Any private individual with knowledge of Medicare fraud or a false claim made to the Government, may bring a Medicare Qui Tam action.  A person bringing a Qui Tam action is called a “Relator.” The Relator stands in the shoes of the Federal Government, when bringing a Medicare fraud Qui Tam action.  The Government may elect to intervene in the case.  If the Government does not wish to intervene, it may do so at a later date.  A Relator may not bring a false claims act action based on public information or information from official proceedings, unless the Relator is the original source of the information.  Furthermore, a Relator may not bring an action where a private individual has raised a similar Medicare fraud Qui Tam action.

Medicare Qui Tam actions are generally brought by providers who have evidence of fraud against an employer or former employer. Qui Tam cases are also commonly brought against suppliers and other providers who the provider/realtor has knowledge of the fraud.

Types of Medicare Qui Tam Actions:

  • Fraudulently billing Medicare, Medicaid, Tricare, etc.
  • Overbilling, upcoding, billing for procedures not provided.
  • Violations of Stark and the Anti-Kickback Statute by physicians, pharmacies, laboratories, etc.
  • Improper registry agreements.
  • Recovery under the Medicare Incentive Reward Program.

Government Intervention in Medicare Qui Tam Actions

A Medicare fraud Qui Tam action is filed under seal for approximately sixty (60) days. The Relator serves the Department of Justice Civil Division (“DOJ”) with a copy of the Complaint.  The DOJ has sixty (60) days to investigate the case and determine if it wishes to intervene.  Routinely, the DOJ will notify the Court that it makes no decision on intervention, reserving the right to intervene later.  If the Government does not intervene, a Relator can earn up to 30% of the judgment or settlement.  If the Government chooses to intervene, the Relator will earn a lower percentage of the recovery.

Our Medicare Qui Tam Attorneys

Medicare fraud Qui Tam Whistleblower cases are often very complex. They require the skill of an attorney who frequently deals with the complex Federal laws pertaining to the False Claims Act. Our team of attorneys includes a former Medicare prosecutor who has many years of experience handling claims against providers on behalf of Medicare. He is exceptionally knowledgeable in fraud and abuse laws, including false claims, anti-kickback, and Stark laws. Our team of attorneys also includes a former Medicaid prosecutor who is also highly experienced in prosecuting fraud claims against health care providers. Our team of Medicare Qui Tam attorneys is able to handle the most complex qui tam cases. We represent both defendants and health care providers who seek to file a Medicare Qui Tam action.

If you feel that you have a Medicare fraud Whistleblower Claim or have been named in a Medicare Qui Tam action, contact our Medicare Qui Tam attorneys immediately.

Comparison of Health Care Fraud Statutes and Penalties


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