As qui tam litigation is expensive, lawyers who specialize in this area of the law typically only accept cases with a high likelihood of success that will yield a sizable dollar amount. These cases, regulated by the False Claims Act, consist of a variety of matters where an unscrupulous person or entity has defrauded the U.S. government. Many of the cases are health-care related and stem from fraudulent Medicare or Medicaid claims. Many others have to do with government contracts with companies that provide materials or services or both.

The principal activities that constitute violations under the False Claims Act are:

1. Knowingly presenting a false or fraudulent claim for payment to the Federal Government;
2. Knowingly using a false record or statement to get a claim paid by the Federal Government;
3. Conspiring with others to get a false or fraudulent claim paid by the Federal Government; and
4. Knowingly using a false record or statement to conceal, avoid, or decrease an obligation to pay money or transmit property to the Federal Government.

Below are some examples of False Claims Act violations and the kinds of cases that a qui tam attorney would consider. Note that the False Claims Act covers fraud involving any federally funded contract or program, with the exception of tax fraud, which is specifically excluded and covered under other laws. It also does not provide a remedy for government waste or mismanagement. • Improper billing to the Medicare or Medicaid program by a physician, hospital or individual.

• Inaccurate diagnosis codes reported from a hospital to obtain Medicare or Medicaid payments.
• Kickbacks to physicians to induce them to prescribe certain medical devices or prescription medications.
• False claims to Medicare or Medicaid for medical services rendered.
• Inappropriate use of Food Stamps.
• Falsification by a contractor of test results or other information regarding the quality or cost of products it sells or services it provides to the government.
• A grant recipient charging the government for costs not related to the grant.
• A contractor quoting inflated prices on a government contract.

Note that those who are in violation of the False Claims Act are liable for three times the dollar amount that the government is defrauded (referred to as treble damages), plus civil penalties of $5,500 to $11,000 for each claim. The “relator” or whistleblower may receive 15-30% of these damages as a reward for having filed the case.

There are many more scenarios. If you believe you know of a fraudulent act against the government, contact a qui tam attorney as soon as possible to see if you have a case.