Think You Have A Case?

Take your time to clearly describe your understanding of the situation. The more detailed the response, the more likely it is that we will be able to evaluate and determine if your potential case that falls within our case requirements. IF IT DOES, WE WILL RESPOND TO YOU WITHIN 24 HOURS. (Names of potential Defendants or anyone else are not necessary at this point, should you feel more comfortable omitting them.)

Your information is sent directly to Nolan & Auerbach and is confidential and protected.
Contact Information
Name
State
Phone Number
Email for reply
Please answer the following questions to the best of your ability.
When may we contact you?:
Describe the kickbacks / inducements utilized (i.e. honoraria, preceptorships, entertainment, clinical trials, grants, administrative fees, etc.) If applicable, describe the pricing fraud utilized.:
Describe the recipients of the kickbacks/inducements (i.e. physicians, managed care, pharmacies, pharmacists, etc.):
Is the conduct still going on?:	Yes No
Please give applicable years:
How did you find out that there was fraudulent activity taking place?:
Is your knowledge of the kickbacks/inducements or pricing fraud first hand knowledge, or did you find out from someone else?:
Do you have in your possession any documents, papers, or other written proof?:	Yes No If so, describe:
Please list the gross U.S. sales, by year, for the drug product(s) at issue for those years you have specific first-hand knowledge that the kickback/inducements or inappropriate pricing activities, were taking place:
Were you an employee of the company committing the fraud?:	Yes No
If so, what is your position?:
If YES, are you still an employee?:	Yes No
If NO, when were you last employed by the company?
Please confirm that upper management was aware that the kickback/inducements were taking place, and/or facilitated the kickback/inducements:	Yes No Not Sure
Have you reported this to anyone in the Government? Explain.:
If YES, when did you report it?:
Does the media, (Television, newspapers, etc.) have any knowledge of this fraud? Explain.:
Assuming that your allegations have merit, would you be willing to come forward and formally file a false claims suit against this company?:	Yes No Not at this time
Any other comments or facts you would like us to know?
Please read the following statement and click "Send Form" below. Any response to your e-mail will be solely to communicate about our possible representation of you under the qui tam provisions of the Federal False Claims Act only. All emails submitted to us, whether we take your case or not, are 100% confidential. If we do not respond to your e-mail, then you have communicated information which we cannot address because it appears to fall outside of the Federal False Claims Act or our case requirements.