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False Claims Act and Whistleblower Lawsuits

A California False Claims Act Lawyer for Whistleblowers and Qui Tam Lawsuits

Whistleblowers who witness fraud or uncover crimes going on in their companies have a choice to make, as whistleblower lawyers in California know: to tell or to keep quiet. As a California False Claims Act lawyer will caution you, you could risk professional repercussions if you decide to reveal what you know—being snubbed, losing your job or being blackballed within your company and other related lines of work. But when you keep quiet, especially about fraud that affects a large number of taxpayers or beneficiaries, the criminal activity could continue indefinitely, draining federal funds and jeopardizing legitimate services that Americans need.

To offset the risks, the government has put laws in place to protect whistleblowers who come forward about fraud that involves government agencies or programs, such as Medicare and Medicaid, from negative results, and, in some cases, rewards their risks. One of these laws is the False Claims Act, which allows a whistleblower to file a qui tam lawsuit to report government fraud.

What is a Whistleblower Lawsuit?

False Claims Act lawsuits are known as qui tam claims.  According to the False Claims Act, any whistleblower whose qui tam suit results in the recovery of government money will receive financial awards and job protection, in recognition of the personal and professional risks that have been taken. Many qui tam lawsuits are aimed at high-level fraud schemes within the federal government and the media attention and potential for blowback from an employer or government official can put a person who uncovers or witnesses fraud in fear of losing his or her job or suffering other negative consequences.

Some common types of false claim whistleblower cases include:

  • Medicare Fraud
  • Medical Fraud
  • Government Contractor Fraud
  • Mortgage Fraud
  • Billing the Government (local, state or federal) for goods or services there were not provided
  • Overcharging the Government (local, state or federal) for good or services
  • Illegal Kickbacks (by pharmaceutical or other companies)
  • Healthcare, Pharmaceutical, and Medical Equipment Fraud

Filing a Qui Tam Lawsuit with a California False Claims Act Lawyer 

Once a person has gathered evidence of fraudulent activity being committed against a government agency, the first step is to obtain legal representation from a California False Claims Act lawyer. A lawyer will be able to navigate legal responsibilities and the protections afforded in the False Claims Act, which will help a whistleblower retain his or her job (if wanted), and avoid illegal consequences from being incurred.

A qui tam lawsuit will be filed “under seal,” so that the information is kept secure from all parties except the government. During this time, the Justice Department will conduct an investigation into the allegations, without informing the accused parties about the case. If the government then decides to intervene in the lawsuit, the case will be sealed for 60 days, although this can be extended if the government investigation takes longer than 60 days.

If a defendant is found guilty of fraud under the False Claims Act, he or she may be forced to pay three times the amount lost by the government, in addition to penalties assessed for each instance of fraud. The whistleblower will then receive a portion of this award, depending on the information provided.

What Kinds of Conduct Does the False Claims Act Cover?

Generally the Act imposes civil penalties on government contractors who defraud the government. It applies to individuals who:

  1. Knowingly present, or cause to be presented, a false or fraudulent claim for payment or approval, or
  2. Knowingly make, use, or cause to be made or used, a false record or statement material to a false or fraudulent claim, or
  3. Conspires to commit a violation of 1 or 2. 31 U.S.C. § 3730(a)(1)(A) and (B).

These provisions cover a wide range of fraudulent activities, such as:

  • Submitting invoices for goods or services that were never delivered or rendered
  • Submitting invoices for research that was never conducted
  • Double billing
  • Billing for drugs, medical devices and other equipment that has not been approved by government agencies
  • Failing to notify the government of overpayment
  • Submitting a false application for a government loan
  • Selling the government worthless or defective products
  • Misrepresenting the value of imported goods or where the goods came from
  • Inflating the number of hours a contractor worked
  • Misrepresenting that the contractor is a member of a minority group or a veteran
  • Performing unnecessary medical procedures for Medicare reimbursement

To “knowingly” present a false claim does not necessarily mean that the individual in question is certain that the information is false. It also encompasses individuals who:

  • Act in deliberate ignorance of the truth or falsity of the information, or
  • Act in reckless disregard of the truth or falsity of the information

The “knowingly” standard also does not necessarily require a specific intent to defraud; rather, the mere submission of a claim containing false information is enough.  See 31 U.S.C. § 3729(b)(1).

Please contact a California False Claims Act lawyer for more information about the kinds of fraudulent conduct that can give rise to qui tam actions.

Are There Any Exceptions to the False Claims Act?

Yes, in a few limited circumstances. The following types of actions are barred under the False Claims Act:

  • Actions by a former or present member of the armed forces against another member of the armed forces arising out of such person’s service
  • Actions against a member of Congress, a member of the judiciary, or a senior executive branch official if the action is based on evidence known to the government when the action was brought
  • Actions based on allegations or transactions that are the subject of a civil suit or an administrative civil money penalty proceeding in which the government is already a party
  • Actions based on information that is disclosed in judicial documents, congressional documents, or the news media, unless the person bringing the action is an original source of the information.

See 31 U.S.C. § 3720(e).

What Is the Statute of Limitations on False Claims Act Cases?

The statute of limitations in false claims cases is the later of:

  1. Six years after the date on which the violation was committed, or
  2. Three years after the date when facts material to the right of action are known or reasonably should have been known by the official of the United States charged with responsibility to act in the circumstances, but in no event more than 10 years after the date on which the violation is committed. See 31 U.S.C. § 3731(b).

Individuals who are in possession of information that could lead to a False Claims Act case are encouraged to move quickly, as the government looks favorably upon promptness when considering the amount of the relator’s share in False Claims Act case

You Will be Protected by a California False Claims Act Lawyer When You Hire Evans Law Firm 

Even though whistleblowers are protected by law, speaking out against a company or institution committing government fraud can be risky, California IRS whistleblower lawyers say. For this reason, it is important to understand your rights as a whistleblower and the protections you are granted.

When allegations about a company arise, the Securities and Exchange Commission wants to see that the company is taking these allegations against them seriously and separating the allegations from the actual person making them. Although the Securities and Exchange Commission will consider information on the whistleblower’s credibility, the Commission is concerned with employer’s whistleblowers policies and seeing what the company actually does with the whistleblowers allegations. Additionally, the Securities and Exchange Commission wants to see how the employee is treated after the allegations are made, including making sure that the employee/whistleblower is not discriminated or retaliated against because of the allegations he or she makes against their employer.

Such discriminatory actions include termination, demotion, suspension, harassment and any other act that would dissuade a reasonable person from reporting violations. Moreover, if an employee has been wrongfully retaliated against, they may bring a private action in federal court against their employer. If they prevail, they may be entitled to reinstatement, double back pay, litigation costs, expert witness fees, and attorney’s fees. The Securities and Exchange Commission can also take legal action in an enforcement proceeding against any employer who retaliates against a whistleblower for reporting information.

Qui Tam/False Claims FAQs

What Is the Federal False Claims Act? 

The False Claims Act, originally enacted in 1863 to root out defense contractor fraud during the Civil War, is the nation’s oldest whistleblower law. It allows private citizens to file suits on behalf of the federal government against entities (usually the whistleblower’s employer) who have perpetrated fraud or waste against the federal government. Any person who knowingly submits a false claim to the federal government is liable for three times the amount of the government’s damages, plus additional fines.  

What Is the California False Claims Act? 

The California False Claims Act is analogous to the federal act, except that it applies to fraud and waste perpetrated against the state government. Like the federal act, it allows private citizens to file suit on behalf of the state and imposes a penalty of three times the amount of the state’s damages plus fines. 

What Are Some Examples of Fraud and Waste? 

Both the federal and state False Claims Acts apply to individuals and corporations that defraud the government — in other words, to people who steal or misappropriate taxpayer money. Generally, the laws apply to any person who: 

  1. Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;
  2. Knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim

These provisions cover a wide range of fraudulent behavior, such as: 

  • Inflating the number of hours worked on a project that is paid by the hour
  • Submitting invoices for goods or services that were never rendered
  • Overcharging for goods or services 
  • Submitting a false application for a government benefit 
  • Using lower-quality materials than what was billed for 
  • Business kickbacks
  • Failing to notify the government when it has overpaid
  • Misrepresenting a contractor’s minority or veteran status 

These are just a few of the fraudulent activities that are covered under the False Claims Act. Please contact a California qui tam lawyer for more specific information. 

How Do Qui Tam Cases Work? 

Qui tam” is Latin for “who as well.” It is applied to legal actions, such as those under the False Claim Act, where the plaintiff sues the defendant on behalf of the federal or state government. Any individual who has knowledge of fraud or waste being perpetrated against the government is entitled to bring a qui tam action. To begin a qui tam action, the whistleblower hires an attorney to evaluate the merits of their case. If the attorney believes the whistleblower’s case has merit, the attorney will then file a civil complaint, serving a copy of the complaint on the state or federal attorney general to let him or her know of the allegation being made. The attorney general will then conduct investigations and decide whether he or she wants to pursue the case. If the attorney general decides not to pursue the case, the whistleblower is free to pursue it alone. 

What Rewards Might I Be Entitled To? 

If the government intervenes in the action and successfully recovers damages, the whistleblower may be entitled to up to 25% of the government’s recovery. If the government does not intervene, but the whistleblower proceeds alone and is successful at recovering damages, the whistleblower may be entitled to up to 30% of the government’s recovery, in addition to attorneys’ fees and costs. However, the amount the whistleblower is entitled to receive depends on how good the information is and how much he or she helped the government. For example, a whistleblower who does not participate in the fraud and who reports it promptly may be entitled to a more significant share, while a whistleblower who participated in the fraud or delayed reporting it may be entitled to a lesser share. 

Am I Protected from Retaliation by My Employer if I Make a Claim under the False Claims Act? 

The False Claims Act protects whistleblowers from retaliation. Acts of retaliation include: 

  • Termination 
  • Demotion 
  • Reassignment to less desirable tasks
  • Relocation to a less desirable location 
  • Denial of promotion

However, please note that a legal prohibition against retaliation does not mean that retaliation will not occur. Whistleblowers are frequently retaliated against despite the robust protections of the False Claims Act. Rather than preventing retaliation, the False Claims Act provides a legal remedy to whistleblowers if their employers retaliate against them. Please speak with a California qui tam lawyer for more information about legal remedies for whistleblowers. 

Does the False Claims Act Cover Healthcare Fraud? 

Yes. Healthcare fraud is one of the largest sources of False Claims Act actions. This type of fraud is especially lucrative for the perpetrators due to the high costs of healthcare services and the relative ease by which it can go undetected. The primary targets for healthcare fraud are the Medicare and Medicaid programs.  

What Counts as Healthcare Fraud? 

Healthcare fraud occurs in the False Claims Act context when a healthcare provider defrauds government-funded healthcare programs, the largest of which are Medicare and Medicaid. In California, the Medi-Cal program is a frequent target of healthcare fraud. 

Some examples of healthcare fraud include: 

  • Billing for services not rendered
  • Over-billing for services rendered
  • Billing for services that were not necessary 
  • Billing for services rendered to “ghost patients” 
  • Up-coding of services 
  • Referral kickback schemes 
  • Bundling and unbundling (i.e., charging for each service separately to obtain greater reimbursement than if the services were bundled together) 
  • Unnecessarily using an ambulance for medical transport 

What Kinds of Evidence do I Need to Prove Fraud? 

The ideal qui tam plaintiff is someone with a great deal of inside knowledge who is close enough to the fraud to have proof that it occurred but who did not participate in it themselves. The strongest evidence of fraud is physical evidence — documents, emails, text messages, photographs, and recordings (being careful to comply with California’s two-party consent law). A California qui tam lawyer at Evans Law Firm can help you evaluate the strength of your evidence and whether it will be admissible in a qui tam action. Contact our office today for immediate assistance.

Do Not Hesitate to Contact a California False Claims Act Lawyer Today for Your Case

To discuss a potential case, and start the process of filing a qui tam lawsuit, contact a California False Claims Act lawyer at the Evans Law Firm, Inc. today. We can be reached by email at info@evanslaw.com, or by telephone at (888) 503-8267 or (415) 441-8669.

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