Qui tam is short for the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which roughly translates to “he who brings an action for the king as well as for himself.” How does the Qui Tam definition relate to litigation today?

Today the federal False Claims Act (“FCA”) is the federal statute originally enacted in 1863. Many cases are filed under 31 §§ 3729 – 3733 by the government. But the FCA also allows private citizens to file suits on behalf of the government. These are called Qui Tam law suits. The private party is called a “relator” and they are the ones who bring an action on the government’s behalf. The government, not the relator, however, is considered the real plaintiff. Note if successful, a relator in a FCA Qui Tam action can receive up to 30% of the government’s award. The False Claims Act authorizes Qui Tam actions against parties who have defrauded the federal government. Qui Tam law suits are also called “whistleblower” law suits. How does it apply in the Health Care Field?

All Qui Tam actions involve actions against parties who have defrauded the federal government. Therefore, any current or former employee, consultant, independent contractor etc working in the medical field who has knowledge of schemes to defraud Medicare or Medicaid may be able to file a Qui Tam lawsuit. What types of schemes to defraud the federal government in the Health Care field are common?

Although not an exhaustive list, below are some common schemes to defraud:

-upcoding

-billing for dead patients

-billing for ineligible patients

-billing for services not provided

-unbundling

-kickbacks

-providing services that were not reasonable or medically necessary and/or failed to provide adequate and appropriate services to its patients.

Please see https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal-year-2020 for details on FCA claims for the year 2020.

Should you have additional questions or concerns about a potential whistleblower case for SEC, Health Care, Procurement, Education/Grant or Tax Fraud, please feel free to reach out to Conaway & Strickler, PC for more information. 404-816-5000 or info@cs-lawyers.com

The Department of Justice (DOJ) has already charged and convicted many cases of PPP loan fraud. But, the purpose of this post is that, recently, the DOJ announced the first (publicized) civil settlement resolving PPP loan fraud allegations against a company and its owner. The owner and SlideBelts, Inc was required to pay a $100k civil penalty per FIRREA civil penalty provision 12 USC 1833a and the False Claims Act (FCA) 31 USC 3729 in the Eastern District of California. The DOJ continues to be aggressive and swift in bringing criminal charges, but, this is the first public civil settlement. Please see https://www.justice.gov/usao-edca/press-release/file/1352931/download to read it in its entirety. The SlideBelts loan application for $350k was misleading as to whether or not the company was in bankruptcy. This means that each and every box checked/information provided was scrutinized. The bank reviewed the application and still paid the loan but then the DOJ argued that the PPP loan application was false and misleading. In this case, SlideBelts worked with law enforcement and the bankruptcy court to acknowledge the issue and worked to settle the case without criminal charges. Claims made by PPP loan borrowers can and will continue to be scrutinized by the DOJ. And even in the absence of clear false statements, it is becoming increasingly clear that the DOJ is investigating and auditing PPP Loan cases. SBA continues to audit applications, especially those over $2 million. If you are unclear whether you need assistance with your loan or PPP or EIDL loan application or if you are being investigated, call federal criminal lawyers, Conaway & Strickler, PC