A qui tam case, also called a whistleblower case, is filed when an employee witnesses fraud and takes legal action on behalf of the government.

What is a qui tam case?

Qui tam is the shortened version of the Latin phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur” which can be roughly translated to “he who sues in this matter for the king as well as for himself.”

Qui tam cases are brought by individuals called “relators” who are not affiliated with the government but bring lawsuits on government’s behalf. In some cases, relators are employees of the accused organizations, but this is not always the case.

Qui tam cases can be brought under various state or local laws, but are most often brought under the federal False Claims Act.

What is the False Claims Act?

The False Claims Act was passed during the Civil War by President Abraham Lincoln to combat the rampant fraud committed by both sides during the war. Contractors were selling sick horses and mules, faulty rifles, defective ammunition, rancid food, and other items that were not worth what the government paid. The False Claims Act allowed the government to take action against these fraudulent contractors and recover compensation.

A key aspect of the False Claims Act is the ability for private individuals known as relators to file claims under the law on behalf of the federal government. Under the False Claims Act, relators who successfully bring a suit and recover damages for the government can collect between 15 and 25 percent of any recovery as compensation for their services.

Of all False Claims Act lawsuits filed, around 70 percent are initiated by relators. Between 1987 and 2013, the government reportedly recovered $27.2 billion from qui tam cases filed under the False Claims Act.

When might a qui tam case be applicable?

Qui tam cases can be filed under the False Claims Act and other laws when there is any instance of fraud against the government. The most common situations involve health care fraud (Medicare, Medicaid, Tricare, etc.), military fraud (government contractors, etc.), tax fraud, and fraud of government spending programs.

In February 2019, Avanti Hospitals agreed to pay $8 million to resolve claims that they used an illegal referral scheme which resulted in fraudulent claims to Medicaid and Medicare. The scheme allegedly provided kickbacks to doctors who made referrals for Avanti medical services covered by Medicaid, Medicare, and other federal healthcare programs. The illegal scheme was revealed by the former CEO of an Avanti hospital who served as the whistleblower for the case.

In March 2019, a qui tam settlement of at least $775,000 was reached between the federal government and Vital Life Institute, a Florida pharmacy. The settlement resolve claims that Vital Life paid kickbacks to third party marketing companies which helped bring patients into the pharmacy for compounded drug prescriptions. This allegedly resulted in patients receiving prescriptions they didn’t need, illegal kickbacks, and fraud of both Tricare and Medicare.

In September 2020, Cigna faced a whistleblower lawsuit from a former employee. According to the complaint, Cigna engineered a fraudulent diagnostic system that resulted in countless Medicare claims without the input of a physician.

In May 2022, a California behavioral health provider agreed to pay $650,000 to resolve claims that it submitted false claims for cancelled appointments and other services that weren’t actually completed. The whistleblower in this case recovered $130,000 for their part in the lawsuit.

If you witnessed healthcare fraud, you could serve as a whistleblower in a qui tam lawsuit. Should your case go to trial, you could recover thousands of dollars for your role as whistleblower.

Whistleblowers are protected from retaliation under the False Claims Act. This means that, even if you file a whistleblower lawsuit against your employer, your employer cannot fire or demote you as retaliation for your role in the False Claims Act lawsuit.

This article is not legal advice. It is presented
for informational purposes only.