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What Is a Qui Tam Lawsuit?

Categories: Health Care Law

qui tam lawsuit

 

Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
Direct: (214) 469-9009
1-800-810-0259
Including Weekends

Oberheiden & McMurrey, LLP has significant experience in advising and defending clients in False Claims Act and Qui Tam Defense matters. Our nationally recognized Healthcare Fraud Defense Group is headed by Dr. Nick Oberheiden. Dr. Oberheiden is a healthcare fraud defense attorney and managing principal of Oberheiden & McMurrey, LLP.

What Happens in a Qui Tam Lawsuit?

The federal False Claims Act allows private citizens to file so-called qui tam lawsuits against individuals and businesses that are suspected to defraud the federal government. In this context, the expression “qui tam” stands for an old Latin phrase best translated with “he who sues for the king and himself.” The archaic phrase articulates the key concept: someone (called a “relator”) sues on behalf of the king (i.e. the government) and himself or herself. Today, this construct is regulated at 31 U.S.C. § 3729 and qui tam and whistleblower lawsuits are among the most common and dangerous threats to healthcare providers that receive remuneration from Medicare, Medicaid and other federal healthcare programs.

Complaint. To initiate a qui tam lawsuit, the plaintiff, known as the “relator” files a complaint, on behalf of the government, in federal court. The relator may name one or multiple defendants, and the defendants may be entities or individual people. Whereas the complaint in a typical case becomes part of the public record upon filing, a qui tam complaint is filed “under seal”, meaning off the public record, so that the relator can remain anonymous. Thus, the only people who receive a copy of the complaint upon filing are the U.S. Attorney’s Office, the judge to whose docket the case is assigned, and pertinent federal administrators.

Evidence.  Upon initiating the qui tam action, the relator must include with the complaint a “Disclosure Statement”, which is a thorough declaration of the relator’s factual basis for the qui tam complaint.  The primary purpose of the Disclosure Statement is to give the government a starting point for its investigation, and the government often uses the Disclosure Statement to evaluate the strength of a qui tam action before investing a lot of time and resources into further investigation of the case.  The Disclosure Statement also serves as a litmus test to help the prosecutors determine whether or not to intervene in the lawsuit and take over prosecution of it from the relator.  Prosecutors are less likely to intervene in the case or investigate the relator’s claims if the Disclosure Statement contains weak factual bases or exhibits clear subjectivity or bias on the part of the relator.  For cases where the government does decide to launch a full investigation, they may employ the resources of other federal agencies, such the FBI and the DEA, in addition to issuing administrative subpoenas to defendants and third parties demanding the production of relevant documents.

Is the Case Civil or Criminal?

Investigations into health care fraud may be either civil or criminal, or both.  The nature of the investigation depends on whether the government is pursuing monetary penalties, making it civil, or criminal charges, making it criminal.  Given that approximately 1,400 individuals are indicted on criminal charges for health care fraud every year, determining whether an investigation is civil or criminal is a threshold issue in developing a defensive strategy in response to the investigation.
The experienced defense attorneys and former prosecutors at Oberheiden & McMurrey, LLP are often able to develop a good sense of the nature of an investigation just from speaking with our clients and hearing their version of events. We catch the pertinent details and nuances of the investigation that may not stick out to the untrained eye. We look for such indicators as the government agencies and officials involved in an investigation or the type of notification a client receives in our analysis of the nature of the investigation.
Call Oberheiden & McMurrey, LLP today for a free and confidential initial consultation with our experienced attorneys.  

Government Intervention?

Following an investigation, the prosecutors must decide whether or not to “intervene” in the qui tam suit.  If they intervene, they will take over the lawsuit from the relator and prosecute it on their own.  Upon intervening, the prosecutors will amend the complaint to include information gleaned from their investigation, and they often also include additional charges, such as violations of the Truth in Negotiation Act, the Anti-Kickback law, the Stark Law, and various aspects of the common law.  If the government does not intervene, they can either allow the relator to continue pursuing the case alone, or they can move to dismiss the case.

In practice, most qui tam actions settle out of court before the prosecutors have a chance to formally intervene. Once the government investigators have served their subpoenas and interviewed their witnesses, and the defendants learn of the pending investigation against them, the attorneys for the defendants and the government usually begin discussions about a potential settlement.  As investigations into False Claims Act violations can a year or more to complete, defense counsel has ample time to negotiate an out of court resolution before the investigation terminates in a trial.  

The decision to intervene in a qui tam action often involves Department of Justice administrators in addition to local prosecutors.  In practice, intervention is the exception instead of the rule; the Department of Justice intervenes in less than 25% of all qui tam lawsuits.

Qui Tam Defense Lawyers

  • Dr. Nick Oberheiden is a Harvard-trained and internationally educated healthcare fraud defense attorney. Nick has successfully represented healthcare executives, business owners, public officials, physicians, and lawyers in high profile prosecutions, scores of political corruption, government investigations, and media campaigns, including 60 Minutes. He is most known for stopping federal investigations before criminal charges can be filed. In addition to his healthcare defense practice, Nick leads internal investigations, implements corporate compliance programs, and teaches U.S. criminal law and federal litigation in the United States and abroad.
  • Attorney Lynette S. Byrd focuses her practice on civil and criminal litigation, Medicare and insurance audits, and general advice and counseling in health care law. She is a former Assistant United States Attorney with years of substantial trial experience under her belt who merges excellent litigation skills with profound understanding of the law.

We are available every day of the year, 24 hours a day. You can call us directly or complete our contact form or by emailing us directly.

Success Stories

Our team of former federal prosecutors, senior government officials, and nationally demanded lawyers has successfully achieved a great number of dismissals and no-charge outcomes for physicians and healthcare owners throughout the country. Below are some recent examples.

  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Toxicology Laboratory
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Business
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Business
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Business
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Business
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Business
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
  • Qui Tam Lawsuit Filed Against Healthcare Provider
    Result: No civil, no criminal liability.
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
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