<?xml version="1.0" encoding="UTF-8"?>
<rss version="2.0"
     xmlns:content="http://purl.org/rss/1.0/modules/content/"
     xmlns:wfw="http://wellformedweb.org/CommentAPI/"
     xmlns:dc="http://purl.org/dc/elements/1.1/"
     xmlns:atom="http://www.w3.org/2005/Atom"
     xmlns:sy="http://purl.org/rss/1.0/modules/syndication/"
     xmlns:slash="http://purl.org/rss/1.0/modules/slash/"
     xmlns:georss="http://www.georss.org/georss"
     xmlns:geo="http://www.w3.org/2003/01/geo/wgs84_pos#"
     xmlns:media="http://search.yahoo.com/mrss/">
    <channel>
        <title><![CDATA[Qui Tam - Conaway & Strickler]]></title>
        <atom:link href="https://www.conawayandstrickler.com/blog/tags/qui-tam/feed/" rel="self" type="application/rss+xml" />
        <link>https://www.conawayandstrickler.com/blog/tags/qui-tam/</link>
        <description><![CDATA[Conaway & Strickler's Website]]></description>
        <lastBuildDate>Sat, 06 Jun 2026 21:41:03 GMT</lastBuildDate>
        
        <language>en-us</language>
        
            <item>
                <title><![CDATA[False Claims Act – Zafirov 11th Circuit Ruling Coming Soon]]></title>
                <link>https://www.conawayandstrickler.com/blog/false-claims-act/</link>
                <guid isPermaLink="true">https://www.conawayandstrickler.com/blog/false-claims-act/</guid>
                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Sat, 06 Jun 2026 20:58:10 GMT</pubDate>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Federal Crimes]]></category>
                
                    <category><![CDATA[Federal Offenses]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                
                    <category><![CDATA[healthcare enforcement action]]></category>
                
                    <category><![CDATA[healthcare fraud]]></category>
                
                    <category><![CDATA[healthcare fraud defense]]></category>
                
                    <category><![CDATA[healthcare professional defense]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                    <category><![CDATA[Qui Tam Litigation lawyers]]></category>
                
                
                
                <description><![CDATA[<p>The Eleventh Circuit is currently considering the constitutionality of the False Claims Act’s Qui Tam Provisions. The Whistleblower on Trial: The History and Uncertain Future of Zafirov v. Florida Medical For over a century, the False Claims Act (FCA) has been the federal government’s most potent weapon against fraud. At its core sits the qui&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>The Eleventh Circuit is currently considering the constitutionality of the<a href="https://www.justice.gov/civil/false-claims-act" id="https://www.justice.gov/civil/false-claims-act"> False Claims Act’</a>s Qui Tam Provisions.  </p>



<p></p>



<p><strong>The Whistleblower on Trial: The History and Uncertain Future of <em>Zafirov v. Florida Medical</em></strong></p>



<p><br>For over a century, the False Claims Act (FCA) has been the federal government’s most potent weapon against fraud. At its core sits the <strong>qui tam</strong> provision—a mechanism allowing private citizens (called “relators”) to sue companies on behalf of the government and pocket a portion of the recovered funds.<br></p>



<p>But a case in Florida has put the entire multi-billion-dollar whistleblower framework on trial. The case is <a href="https://www.uschamber.com/cases/false-claims-act/zafirov-v-florida-medical-associates-llc-2" id="https://www.uschamber.com/cases/false-claims-act/zafirov-v-florida-medical-associates-llc-2"><em>United States ex rel. Zafirov v. Florida Medical Associates, LLC</em>.</a> After lower-court rulings and tense appellate arguments in December 2025, the legal and healthcare worlds are anxiously awaiting to see how the Eleventh Circuit Court of Appeals will rule.<br><br><strong>The History of this False Claims Act suit: How We Got Here</strong></p>



<p><br>The story began when Dr. Clarissa Zafirov, a physician in Florida, alleged that her employer and other defendants engaged in systemic <a href="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/health-care-fraud/" id="https://www.conawayandstrickler.com/criminal-defense-practice/federal-crimes/federal-white-collar-crimes/federal-fraud/health-care-fraud/">Medicare fraud</a> by misrepresenting patient conditions to pad federal reimbursements. The U.S. government chose not to intervene, leaving Dr. Zafirov to spearhead the complex litigation herself.<br></p>



<p>The defendants, however, didn’t just fight the fraud allegations; they attacked the constitutional foundation of the lawsuit. In September 2024, U.S. District Judge Kathryn Kimball Mizelle dropped a bombshell by dismissing Zafirov’s suit. She didn’t rule on whether fraud occurred. Instead, she ruled that the False Claims Act’s qui tam provisions are unconstitutional.<br></p>



<p><strong>The Article II Battleground</strong></p>



<p><br>Judge Mizelle’s ruling hinged on the <a href="https://constitution.congress.gov/browse/essay/artII-S2-C2-3-1/ALDE_00013092/" id="https://constitution.congress.gov/browse/essay/artII-S2-C2-3-1/ALDE_00013092/">Appointments Clause of Article II </a>of the U.S. Constitution.<br><code>Is a Whistleblower an "Officer of the United States"? ├── YES ──> Must be appointed by the President, Courts, or Dept. Head. (FCA Fails) └── NO ──> Private citizen pursuing a claim. (FCA Succeeds)</code></p>



<p><br>Judge Mizelle argued that because a relator wields significant executive power—conducting civil litigation in the name of the United States to vindicate public rights—they act as an “Officer of the United States.” Because Dr. Zafirov appointed herself to this role by simply filing a complaint, her status bypassed constitutional appointment protocols.  <em>“Zafirov has determined which defendants to sue, which theories to raise, which motions to file, and which evidence to obtain… Yet no one… appointed Zafirov to the office of relator. Instead… Zafirov appointed herself. This she may not do.”</em><br>— <strong><a href="https://ecf.flmd.uscourts.gov/cgi-bin/show_public_doc?2019-01236-346-8-cv" id="https://ecf.flmd.uscourts.gov/cgi-bin/show_public_doc?2019-01236-346-8-cv">Judge Kathryn Kimball Mizelle</a></strong><br></p>



<p>While decades of judicial precedent across the country had uniformly rejected this argument, Judge Mizelle’s ruling breathed real life into a legal theory previously sparked by Supreme Court Justice Clarence Thomas in a 2023 dissenting opinion (<em>U.S. ex rel. Polansky</em>), where Justices Kavanaugh and Barrett also expressed interest in reviewing the issue.<br><br><strong>The Eleventh Circuit Showdown</strong></p>



<p> <br>The Department of Justice and Dr. Zafirov promptly appealed, leading to highly anticipated <a href="https://www.ca11.uscourts.gov/oral-argument-recordings?field_oar_case_name_value=zafirov&field_oral_argument_date_value%5Bmin%5D=&field_oral_argument_date_value%5Bmax%5D=" id="https://www.ca11.uscourts.gov/oral-argument-recordings?field_oar_case_name_value=zafirov&field_oral_argument_date_value%5Bmin%5D=&field_oral_argument_date_value%5Bmax%5D=">oral arguments </a>before a three-judge panel of the Eleventh Circuit on December 12, 2025.<br></p>



<p>The panel –  Circuit Judges Elizabeth L. Branch, Robert J. Luck, and Senior District Judge Federico A. Moreno—focused intensely on the concept of control.</p>



<p><br>The arguments were mainly over two competing perspectives:<br></p>



<p>1. The Government’s and Relator’s Defense<br>The DOJ shifted its strategy slightly at oral arguments, focusing heavily on the “continuing position” prong of officer status. They argued that an “officer” must occupy a permanent, continuous government seat (like the Secretary of State). A whistleblower is a temporary, self-interested private actor whose role dissolves when the case ends. Furthermore, they argued the government retains ultimate control because it can step in and dismiss or settle the case at any time.<br></p>



<p>2. The Defense and Amici Pushback<br>Attorneys for Florida Medical and supporting business groups argued that when the government declines to intervene (which occurs in roughly 80% of FCA cases), the relator is entirely “in the driver’s seat.” They exercise massive, unaccountable federal authority to issue subpoenas, freeze corporate assets, and force massive settlements without answering to the President.<br><br><strong>Prediction: How Might the 11th Circuit Rule?</strong></p>



<p><br>Predicting appellate outcomes is tricky, but the panel’s questioning in December 2025 offered some clues.  The judges did not treat the constitutionality of the FCA as a settled matter. They repeatedly pressed the DOJ on why Justice Thomas’s strict separation-of-powers logic was wrong.<br></p>



<p>The court essentially faces three paths:<br><br>1) <strong>Reverse the Dismissal</strong> <em>(Uphold the FCA)</em><br>The court aligns with decades of historical practice and other circuits (like the Sixth Circuit’s January 2026 ruling), finding that private bounty-hunters are not public “officers.”  Therefore it would remain business as usual. Whistleblower cases proceed normally in Florida, Georgia, and Alabama.<br></p>



<p>2) <strong>Affirm the Dismissal</strong> <em>(Strike down Qui Tam)</em><br>The panel adopts Judge Mizelle’s and Justice Thomas’s strict textualist view that prosecuting public fraud is an exclusively executive function that cannot be outsourced to unappointed citizens.  This would create Immediate chaos. Hundreds of pending qui tam cases in the Southeast would face dismissal, crippling a primary source of federal fraud recovery.</p>



<p><br>3) <strong>The Middle Ground</strong> <em>(Narrow Procedural Fix)</em><br>The court rules that qui tam actions are only unconstitutional <em>if</em> the government completely declines to intervene, or suggests a fix where the DOJ must sign off on major litigation steps.  A logistical headache for the DOJ, which would be forced to actively micromanage cases it initially wanted no part of.</p>



<p><br><strong>The Verdict on the Horizon</strong></p>



<p><br>Given the conservative, textualist leanings of the Eleventh Circuit panel, an affirmance (ruling the qui tam provision unconstitutional) is a highly distinct possibility. The judges seemed genuinely troubled by the lack of day-to-day executive oversight in declined whistle-blower lawsuits.  <br></p>



<p>However, regardless of whether the Eleventh Circuit upholds the law or strikes it down, <em>Zafirov</em> is on a fast track to the ultimate destination. Because a stark circuit split is opening up between courts upholding the False Claims Act and those questioning it, this case is highly likely to end up before the U.S. Supreme Court, where the future of American whistleblower law will be decided once and for all.</p>
]]></content:encoded>
            </item>
        
            <item>
                <title><![CDATA[The DOJ has just announced that recoveries from False Claims Act settlements and judgments in fiscal year 2025 exceeded $6.8 billion]]></title>
                <link>https://www.conawayandstrickler.com/blog/the-doj-has-just-announced-that-recoveries-from-false-claims-act-settlements-and-judgments-in-fiscal-year-2025-exceeded-6-8-billion/</link>
                <guid isPermaLink="true">https://www.conawayandstrickler.com/blog/the-doj-has-just-announced-that-recoveries-from-false-claims-act-settlements-and-judgments-in-fiscal-year-2025-exceeded-6-8-billion/</guid>
                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Thu, 22 Jan 2026 14:07:43 GMT</pubDate>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[federal criminal investigation]]></category>
                
                    <category><![CDATA[health care fraud]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                
                
                    <media:thumbnail url="https://conawayandstrickler-com.justia.site/wp-content/uploads/sites/908/2026/01/image001.jpg" />
                
                <description><![CDATA[<p>Under the False Claims Act, individuals or entities can be held liable for knowingly submitting false or fraudulent claims for payment to the government. The FCA allows private individuals, known as “whistleblowers” or “relators,” to file lawsuits on behalf of the government and share in any monetary recovery. These health care fraud lawsuits are known&hellip;</p>
]]></description>
                <content:encoded><![CDATA[
<p>Under the <a href="https://www.conawayandstrickler.com/blog/recent-overview-of-the-false-claims-act/">False Claims Act,</a> individuals or entities can be held liable for knowingly submitting false or fraudulent claims for payment to the government. The FCA allows private individuals, known as “whistleblowers” or “relators,” to file lawsuits on behalf of the government and share in any monetary recovery. These health care fraud lawsuits are known as qui tam actions. If the government intervenes in the lawsuit and recovers funds, the whistleblower is typically entitled to receive a portion of the recovered amount, often ranging from 15% to 30%. In fiscal year 2023, whistleblowers filed 712 qui tam suits, and this past year the Justice Department reported settlements and judgments exceeding $2.3 billion in these and earlier-filed suits.</p>



<p>“The False Claims Act imposes treble damages and penalties on those who knowingly and falsely claim money from the United States or knowingly fail to pay money owed to the United States. The False Claims Act thus safeguards government programs and operations that provide access to medical care, support our military and first responders, protect American businesses and workers, help build and repair infrastructure, offer disaster and other emergency relief, and provide many other critical services and benefits.”  Settlements and judgments under the False Claims Act <a href="https://www.justice.gov/opa/pr/false-claims-act-settlements-and-judgments-exceed-68b-fiscal-year-2025">exceeded $6.8 billion </a>in the fiscal year ending Sept. 30, 2025, Deputy Attorney General Todd Blanche and Assistant Attorney General Brett A. Shumate, head of the Justice Department’s Civil Division announced in mid January of 2026. Healthcare fraud dominated recoveries, with approximately $5.7 billion of the total $6.8 billion tied to healthcare-related matters that included managed care, prescription drugs, and medically unnecessary services.</p>



<p>In addition, relators also set a new record with 1,297 new <a href="https://www.fedbar.org/blog/understanding-the-basics-of-qui-tam-law/">qui tam suits </a>filed, breaking FY 2024’s record of 980 qui tam suits and nearly doubling the average number of new qui tam suits during <a href="https://www.justice.gov/archives/opa/media/1384546/dl">FY 2010 to FY 2023.</a></p>



<p>it is important for clients to make sure your compliance programs are designed to mitigate<a href="https://www.justice.gov/civil/false-claims-act">FCA</a> risk. Please <a href="https://www.conawayandstrickler.com/contact-us/">contact us</a>, we are here to help whether it is the beginning of an investigation, on the eve of trial, at the appellate stage or during settlement discussions.</p>



<p></p>
]]></content:encoded>
            </item>
        
            <item>
                <title><![CDATA[Startup Online Telehealth Company Executives Indicted]]></title>
                <link>https://www.conawayandstrickler.com/blog/startup-online-telehealth-company-executives-indicted/</link>
                <guid isPermaLink="true">https://www.conawayandstrickler.com/blog/startup-online-telehealth-company-executives-indicted/</guid>
                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Sun, 16 Jun 2024 16:40:32 GMT</pubDate>
                
                    <category><![CDATA[Health Care]]></category>
                
                    <category><![CDATA[Uncategorized]]></category>
                
                
                    <category><![CDATA[health care fraud]]></category>
                
                    <category><![CDATA[medicaid fraud]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                
                
                    <media:thumbnail url="https://conawayandstrickler-com.justia.site/wp-content/uploads/sites/908/2024/06/IMG_1317-scaled-1.jpeg" />
                
                <description><![CDATA[<p>On June 13, 2024, two health care executives of Done Global Inc were indicted for health care fraud related charges. The indictment alleges that the two participated in a scheme to distribute Adderall over the internet, conspire to commit health care fraud in connection with the submission of false and fraudulent claims for reimbursement for&hellip;</p>
]]></description>
                <content:encoded><![CDATA[

<p>On June 13, 2024, two health care executives of Done Global Inc were <a href="https://www.justice.gov/usao-ndca/media/1355871/dl?inline" rel="noopener noreferrer" target="_blank">indicted </a>for health care fraud related charges.  The indictment alleges that the two participated in a scheme to distribute Adderall over the<a href="https://www.donefirst.com/homepage-special-99?utm_source=google&utm_medium=cpc&utm_content=NonBrand-ADHD-CPA2&utm_medium=cpc&utm_source=google&campaignid=20935659831&adgroupid=156387494383&creative=687636644617&matchtype=e&network=g&device=c&keyword=done%20online&gad_source=1&gclid=CjwKCAjwmrqzBhAoEiwAXVpgotqhjM4T0ptF4V80oqw7UegBPcbJU8jZCX8Ad7fn6cJMMqUTqvbfohoCBAEQAvD_BwE" rel="noopener noreferrer" target="_blank"> internet</a>, conspire to commit health care fraud in connection with the submission of false and fraudulent claims for reimbursement for Adderall and other stimulants, and obstruct justice.</p>


<p>“As alleged, these defendants exploited the COVID-19 pandemic to develop and carry out a $100 million scheme to defraud taxpayers and provide easy access to Adderall and other stimulants for no legitimate medical purpose,” said Attorney General Merrick B. Garland.   These arrests mark the DOJ’s 1st criminal drug distribution prosecutions related to prescribing via telemedicine, the agency said.
</p>


<p>Conaway & Strickler represent healthcare providers in fighting against allegations such as these by agencies such as the DOJ, HHS-OIG, FBI, Georgia Medicaid Fraud Control Units and cases nationwide.  We have litigated federal healthcare cases in NJ, NY, LA, FL, TX and GA.  We also represent healthcare providers in medical and professional licensing board matters as well.</p>


<p>
Remember, physicians have to report issues to their professional liability carrier, insurers, etc. AND to the <a href="https://medicalboard.georgia.gov/" rel="noopener noreferrer" target="_blank">Georgia Composite Board</a>.  Thus, it is important to <a href="/contact-us/">contact us</a> immediately when an agent comes knocking asking “for just a few files” or “just a few questions”.  Do not go it alone.</p>


<h1 class="wp-block-heading"></h1>


]]></content:encoded>
            </item>
        
            <item>
                <title><![CDATA[What are the current DOJ priorities?]]></title>
                <link>https://www.conawayandstrickler.com/blog/what-are-the-current-doj-priorities/</link>
                <guid isPermaLink="true">https://www.conawayandstrickler.com/blog/what-are-the-current-doj-priorities/</guid>
                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Fri, 01 Apr 2022 15:03:29 GMT</pubDate>
                
                    <category><![CDATA[Blog]]></category>
                
                    <category><![CDATA[Criminal Defense]]></category>
                
                    <category><![CDATA[Cyber Crime]]></category>
                
                    <category><![CDATA[Cybercrime]]></category>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Federal Crimes]]></category>
                
                    <category><![CDATA[Federal Offenses]]></category>
                
                    <category><![CDATA[Fraud]]></category>
                
                    <category><![CDATA[PPP loan fraud]]></category>
                
                    <category><![CDATA[Tax Fraud]]></category>
                
                    <category><![CDATA[White Collar Crimes]]></category>
                
                    <category><![CDATA[White Collar Offenses]]></category>
                
                
                    <category><![CDATA[#taxevasion]]></category>
                
                    <category><![CDATA[#taxfraud]]></category>
                
                    <category><![CDATA[covid 19 task force]]></category>
                
                    <category><![CDATA[Criminal Lawyer]]></category>
                
                    <category><![CDATA[doj]]></category>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[federal criminal attorney]]></category>
                
                    <category><![CDATA[Federal Criminal Lawyer]]></category>
                
                    <category><![CDATA[health care fraud]]></category>
                
                    <category><![CDATA[kickbacks]]></category>
                
                    <category><![CDATA[Medicare Fraud]]></category>
                
                    <category><![CDATA[PPP Loan Fraud]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                    <category><![CDATA[SEC]]></category>
                
                    <category><![CDATA[wire fraud]]></category>
                
                
                
                <description><![CDATA[<p>Attorney General Merrick Garland made recent comments about what he considered to be the Department of Justice’s top priorities for 2022. Since taking office in March 2021, Garland has tried to combat crime in a tumultuous time. He has been criticized for his handling of January 6 investigation and has stated it’s the most urgent&hellip;</p>
]]></description>
                <content:encoded><![CDATA[

<p>Attorney General Merrick Garland made recent <a href="https://www.justice.gov/opa/speech/attorney-general-merrick-b-garland-delivers-remarks-aba-institute-white-collar-crime" rel="noopener noreferrer" target="_blank">comments </a>about what he considered to be the Department of Justice’s top priorities for 2022.  Since taking office in March 2021, Garland has tried to combat crime in a tumultuous time.  He has been criticized for his handling of January 6 investigation and has stated it’s the <a href="https://www.newsweek.com/merrick-garland-jan6-doj-investigation-capitol-rnc-1686802" rel="noopener noreferrer" target="_blank">most urgent probe in history.</a></p>


<p>With all of this going on, the US Attorney’s office <em>increased</em> its prosecutions of individuals of white collar crimes in the year 2021.  White collar charges like fraud, theft, corruption, bribery, environmental crime, tax fraud, health care fraud, procurement fraud, money laundering, PPP loan fraud, etc will continue to get more attention from the Department of Justice.</p>


<p>What does this mean?  It means that investigations of any sort need to be taken seriously and that you should contact a lawyer immediately if any wrongdoing is alleged.</p>


<p>Conaway & Strickler, PC has a long history of handling fraud cases of all varieties and is well equipped at fighting the DOJ in their overzealous prosecutions.  Please feel free to contact us so that we can help you avoid future headaches.</p>


]]></content:encoded>
            </item>
        
            <item>
                <title><![CDATA[Whistleblower / Qui Tam cases in Health Care]]></title>
                <link>https://www.conawayandstrickler.com/blog/whistleblower-qui-tam-cases-in-health-care/</link>
                <guid isPermaLink="true">https://www.conawayandstrickler.com/blog/whistleblower-qui-tam-cases-in-health-care/</guid>
                <dc:creator><![CDATA[Conaway & Strickler, P.C.]]></dc:creator>
                <pubDate>Sat, 11 Sep 2021 16:19:36 GMT</pubDate>
                
                    <category><![CDATA[Criminal Defense]]></category>
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[Federal Crimes]]></category>
                
                    <category><![CDATA[Tax Fraud]]></category>
                
                    <category><![CDATA[White Collar Crimes]]></category>
                
                
                    <category><![CDATA[False Claims Act]]></category>
                
                    <category><![CDATA[FCA]]></category>
                
                    <category><![CDATA[health care fraud]]></category>
                
                    <category><![CDATA[kickbacks]]></category>
                
                    <category><![CDATA[Medicare Fraud]]></category>
                
                    <category><![CDATA[Qui Tam]]></category>
                
                    <category><![CDATA[tax fraud]]></category>
                
                    <category><![CDATA[whistleblower]]></category>
                
                
                
                    <media:thumbnail url="https://conawayandstrickler-com.justia.site/wp-content/uploads/sites/908/2021/09/whistleblowerpa.jpg" />
                
                <description><![CDATA[<p>Health Care Qui Tam cases What does Qui Tam mean? 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&hellip;</p>
]]></description>
                <content:encoded><![CDATA[

<p>
<em>Health Care Qui Tam cases</em>
<strong>What does Qui Tam mean? </strong></p>


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


<p>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.
<strong>How does it apply in the Health Care Field?</strong></p>


<p>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.
<strong>What types of schemes to defraud the federal government in the Health Care field are common? </strong></p>


<p>Although not an exhaustive list, below are some common schemes to defraud:<strong> </strong></p>


<p>-upcoding</p>


<p>-billing for dead patients</p>


<p>-billing for ineligible patients</p>


<p>-billing for services not provided</p>


<p>-unbundling </p>


<p>-kickbacks</p>


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


<p>Please see <a href="https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal-year-2020" rel="noopener noreferrer" target="_blank">https://www.justice.gov/opa/pr/justice-department-recovers-over-22-billion-false-claims-act-cases-fiscal-year-2020</a> for details on FCA claims for the year 2020.</p>


<p>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</p>


]]></content:encoded>
            </item>
        
    </channel>
</rss>