The Big Picture on “Whistleblowing”

Amber Williams, Attorney

In light of the near national government shut-down two weeks ago and the overwhelming concern in the news with the national budget crisis, I started thinking about the False Claims Act, which helps the government recover monies for the American public. As the state and federal governments go further into the red any potential income becomes increasingly precious, the False Claims Act is gaining both popularity and importance.

The False Claims Act,  also known as the “Qui Tam Act” or “whistleblowing,” has been a part of our legal system over 150 years. If a company is filing fraudulent claims with the government and receiving government money based on those claims, a “whistleblower” (usually an employee) may bring a case against the fraud on behalf of the government. In these types of cases, the person filing suit – the Relator – is a joint party with the government against the fraudulent company, and is therefore entitled to a percentage of any award in the suit.

It’s easy to understand why citizens like this act: they have a chance to do the right thing of helping to defend their government against being defrauded – and potentially receive a reward for doing so. What may not be so obvious here is the importance or scale of the money recovered and how recovering it is good for the American people.

Last week in Miami Dr. De Los Rios was convicted of five felony counts having to do with Medicare fraud. So what did he do? For approximately 2 ½ years he falsified documents to bill Medicare for services which were not actually administered and prescribed expensive medication unnecessarily just for the Medicare reimbursement. These actions cost the Medicare program almost $12 million of tax-payer dollars. That’s $12 million Floridian dollars which easily could have been put to better use for the public. In fact, since 2007, over a 1,000 charges have been brought against suspected falsified Medicare claimants – to the tune of $2.3 billion American dollars.

So the good news is: all this money which was falsely paid out by the government can be recovered, reclaimed, and re-circulated back into the state and national budgets. And the individual who “blew the whistle” on the fraud is compensated for their assistance. Everyone goes home happy, right? So why aren’t there more whistleblowers all over the place? Why don’t we hear about False Claim suits everyday?

Because many people are afraid to speak up. They have a number of very understandable questions, like: “How does it work?” and “What do I do if I want to blow the whistle on someone?”

The short answers to these questions are: “It’s complicated.” and “Call an attorney.”

The long answers are:

“How does it work?”

First, your attorney will file a lawsuit under seal in Federal court and serve the offices of the US Attorney General and the local US Attorney with a copy of the complaint, along with a written disclosure. Neither the defendant nor the public will be made aware of the lawsuit. The government attorneys will have 60 days to decide if they would like to intervene in the suit against the defendant, file an extension to investigate further, or decline to pursue the case. If they decline to intervene, you can still continue with the suit on your own. If the federal or state attorneys decide to intervene it will affect the amount of work and involvement for you and your attorney. Moreover, it will also affect the amount of compensation you will receive if the suit is successful and results in awards for the plaintiffs. The more work the federal and state attorneys do, the less you’ll receive as a whistleblower in the end.

“What do I do if I want to blow the whistle on someone?”

Qui tam claims have a very specific process and must be filed by an attorney within a certain timeframe. So, don’t wait if you feel that there is a whistle to be blown. A False Claim suit needs to show that the defendant “knowingly submitted a false claim to the federal government” such as “any written or electronically submitted request or demand…for money, property, or services” from a government agency. You may have a case if you have any direct and independent information about the actions. Whatever the situation, you should speak with an attorney who is experienced in helping you determine what steps to take.

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