We prosecute Healthcare Fraud (which includes Pharmaceutical fraud and Medicare Fraud) lawsuits for whistleblowers under the qui tam provisions of the Federal False Claims Act. We have limited ourselves to Healthcare Fraud qui tam cases as we believe we can serve our clients better that way. We have full familiarity and experience with the statutes, regulations and CMS and OIG views on the various areas of Healthcare Fraud. We have Published Articles in various areas of Healthcare Fraud, are a source for the media (In the News), and have a track record of Recent Notable Cases.

First, we will conduct a very preliminary investigation. This includes verifying the information that you furnish to us, as well as obtaining more information. If we believe that there may be a substantial, provable case, we will begin our investigation and utilize all of the tools and resources that are available to develop and prove your allegations. Once our investigation is complete, we will begin drafting the documents necessary to file the qui tam. This will include further factual analysis, legal analysis, and application of the law to the facts. The point is to make the case as complete and clear as we possibly can. Within this process, we draft the Complaint and what is called a Disclosure Memorandum. Upon further confirming of the viability of the case, and after approval by our client(s) of the specific Complaint allegations, we will file the Complaint with the Court and serve it on the government attorneys. (A week or so before we do this, we typically make contact with the U.S. Attorney’s Office in the District we will file in).

The case is filed “under seal” in federal court. This means that neither the company the case is being filed against, nor anyone else other than the government, is informed.  Similarly, our clients cannot disclose its existence directly or indirectly to anyone.  Failure to keep the seal will result in Court sanctions, up to dismissal.

Because qui tam cases based on the same or similar allegations to an earlier case are subject to dismissal, it is critical to file the case first. The Relator (with adequate information and details) that is first to file the case will be the only Relator who can pursue the case on the same allegations.

After a copy of the Complaint (and other material and information) is provided to the Department of Justice and the local United States Attorney’s office, they then have a period of time (the “seal period”) in which they, and other offices such as the Inspector General of the Department of Health and Human Services, can investigate the alleged false claims. The FBI also investigates Healthcare Fraud False Claims Act cases, as well as agents from the FDA and the Defense Criminal Investigative Service.

Prior to making the decision of whether or not to intervene, the government also typically chooses to discuss the circumstances with our client(s). The meeting typically lasts no longer than one day.

The entire seal period could last 2 to 4 years, and sometimes many more. Typically there is nothing more for our client(s) to do once the case gets to this point, outside of answering additional questions or reviewing documents.   In rare cases, our client(s) may be asked to wear a wire or tape record conversations (if they still work for the company on which they have blown the whistle). Wearing a wire or tape recording conversations is entirely voluntary.

If there will be a criminal investigation, we will not receive any details on the who, what, when, where and why of anything that the Government has been doing. Because it is a criminal investigation, our clients are not entitled to such information. No Relator is.  Even the civil side of the U.S. Attorney’s Office is not entitled to Grand Jury information, except upon successful application to the Court.  Other than one’s own frustrations and emotions at not being able to find out what is going on in the criminal investigation, there is no adverse affect whatsoever.  The same principle applies to the civil investigation, but sometimes less so. This is one of the trade-offs in what is what we believe to be a tremendous process (qui tam) that has the potential to vindicate whistleblowers and pay them well for doing the right thing.

Then, when the government decides to intervene or not, the seal is lifted, the company is informed of the allegations against it, and the lawsuit proceeds. The distinction in qui tam lawsuit is that both the United States and our clients are co-plaintiffs. Your main responsibility at that point would be to appear for a deposition, assist us concerning any further information or analysis needed, and of course, if there is a trial, to attend and testify at trial.

These cases take years. There is no instant fix to your situation or the fraud. We have repeated this many times to clients when their cases are a couple of years old – please try to have patience.  It is difficult, but it is better for you personally, in our opinion.  Go on with your lives – keep yourselves busy with your jobs, family, outside interests, and so on.

Caveat:  The process and occurrences that we describe and predict are done so only in general, in terms of time frames and possible events. This case may take twists and turns that are neither mainstream nor anticipated. Accordingly, you must not rely on time frames or event stages as certainties.