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. Our law firm practice is strictly limited 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 a long record of published articles on various areas of healthcare fraud, have been an expert source for the media (“In The News”), for over a decade, and have a long track record as noted in our recent notable cases.
If the information that you provide us fits our case requirements, we will conduct a 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 investigate further, and utilize all of the tools and resources that are available to develop and prove your allegations. Once our investigation is complete, and we are retained by you, 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 confirmation 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 completing this process, 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, and the FBI, and/or other agencies can investigate the alleged false claims. As part of the investigation, the government typically chooses to discuss the circumstances with our client(s). The meeting typically lasts no longer than one day.
The entire seal period typically lasts two to four years, but sometimes many more. During this period, in most cases, our clients take an active role in helping us contribute to the government investigation. This includes drafting document requests, providing inside information and strategy, reviewing and analyzing documents and more. In rare cases, our client(s) may be asked to wear a wire or tape record telephone 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 receive few details on the who, what, when, where and why of anything that the government has found. 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 effect whatsoever to the qui tam lawsuit. This is one of the trade-offs in 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.
Next, whether 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 lawsuits 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 the fraud, or a quick resolution to the qui tam lawsuit. We ask our clients after their cases are a couple of years old – to please have patience. It is difficult, but in our opinion, it is better for them to go on with their lives, keeping busy with jobs, family, outside interests, and so on.
- Whistleblower HIPAA Concerns – explains the provision of the Health Insurance Portability and Accountability Act which authorizes whistleblowers to divulge certain confidential information when exposing fraud.
- Whistleblower Protection – gives an overview of how whistleblowers are protected if their employers retaliate against them.
- Whistleblower Rewards – gives an overview of how rewards are calculated under the False Claims Act.
Caveat: The process and occurrences that we describe and predict are done so only in general, in terms of time frames and possible events. Cases can and do take twists and turns that are neither mainstream nor anticipated. Accordingly, you must not rely on the time frames or event stages described here as certainties.