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Virginia Healthcare Fraud Attorney

Virginia False Claims, Qui Tam Lawsuits, & Rewards

  1. What defines Medicare or Medicaid fraud?
  2. What is the False Claims Act?
  3. Who is eligible for a Qui Tam Reward?
  4. What are the deadlines for filing a qui tam lawsuit?
  5. What will happen to my job if I file a lawsuit?
  6. How will a lawyer protect my job if I blow the whistle?

What Defines Medicare, Medicaid, and Healthcare Fraud?

Medicare and Medicaid fraud refers to the illegal practices used to seek unfairly large payouts from the two government-funded health programs. It can be committed by healthcare workers, hospital facilities, patients, program participants, and others pretending to be participants. Common examples of Medicare and Medicaid fraud include:

  • Performing unnecessary tests
  • Making unnecessary referrals
  • Billing for services not actually performed
  • Billing for services not medically necessary
  • Receiving benefits for programs which a person is not eligible for
  • Kickbacks in exchange for patient referrals
  • Submitting false cost reports
  • Submitting multiple claims for payment for a bundled service
  • Up-coding for services and/or goods

As loopholes close and technology evolves, new methods of defrauding Medicare and Medicaid are created all the time. Identity theft, for instance, has increasingly become a challenge for Medicare and Medicaid professionals. Detecting and preventing fraud is a crucial job since these unethical, illegal practices waste valuable funds intended to help some of society’s most vulnerable citizens.

What is the False Claims Act?

Also known as the Lincoln Law, the False Claims Act is a federal law that imposes liability on those who defraud programs like Medicare and Medicaid. The law includes a qui tam provision, which allows non-governmental plaintiffs – called relators – to file actions on behalf of the government. These whistleblowers help to sound the alarm when they discover Medicare or Medicaid fraud. Over 70 percent of all government False Claims Act actions have been initiated by whistleblowers.

Who is Eligible for a Qui Tam Reward?

There’s a big motivation for coming forward with evidence of Medicare or Medicare fraud: whistleblowers are often entitled to a qui tam reward. Typically, relators who file a False Claims Act lawsuit on behalf of the government receive between 15 and 20 percent of the damages recovered.

To be eligible for a quit tam reward, you must meet the “first-to-file” bar. This rule prevents whistleblowers from collecting rewards unless they are the original source of information. So long as you are providing unique, new insight into an individual or organization’s Medicare or Medicaid fraud, you are eligible for a qui tam reward. This reward helps to incentivize whistleblowers to come forward with their findings.

What Deadlines Must be Met for Filing a Qui Tam Lawsuit?

There are many deadlines to meet when filing a False Claims Act lawsuit. The first-to-file rule is perhaps the most important. If someone has already filed a claim about the fraud you’re planning to report, then only the first person who came forward with the claim is eligible for a reward. However, even if you believe someone else has filed suit, you should still seek the insight of an experienced False Claims Act attorney for guidance on what to do next.

The Supreme Court has ruled that whistleblowers have up to 10 years to file a False Claims Act lawsuit. So long as you’re within a decade of the alleged violation, you are in the clear. Obviously, time is of the essence, even within this 10-year window.

What Will Happen to My Job if I File a Lawsuit?

Retaliation against whistleblowers is illegal. While laws are in place to protect workers, some employers may choose to fire those who blow the whistle. If this happens, you may be entitled to additional compensation. Courts have recently stepped up the way they enforce anti-retaliation laws. Still, anyone considering reporting fraud should speak to an attorney first. We can help protect your job and ensure you’re prepared for any possible retaliation.

Depending on your role within your organization, retaliation can be a real issue. In addition to the federal protections under the False Claims Act and the Dodd-Frank Act, there are a number of state and federal laws with anti-retaliation clauses. In some cases, you may obtain benefits from more than one of these laws.

How Will a Lawyer Protect My Job If I Blow the Whistle?

It’s always a good idea to speak to an attorney before blowing the whistle. While retaliation against whistleblowers is indeed illegal, anyone considering sounding the alarm needs to be prepared for the possibility. Though a lawyer cannot prevent you from being fired or otherwise retaliated against, retaining legal counsel can help protect you from the blowback that may occur.

If you’re considering blowing the whistle on Medicare or Medicaid fraud, it’s important to speak with an attorney about your options. Our firm has the experience, resources, and knowledge necessary to pursue justice on your behalf. Call our office today to set up a no-risk consultation to fully explore your options before you sound the alarm on Medicare or Medicaid fraud.

Contact Virginia Whistleblower Attorney Cindra Dowd

We are experienced in whistleblower protections and litigation.  We are here to help you through the legal process of being a whistleblower. Let us help you gain back what you have lost through retaliation. If you have uncovered improper actions taking place in your company, do not hesitate to contact us. We can assist you in receiving the protection you deserve.


    Best Lawyers Recognizes Richard Serpe & Cindra Dowd
    Best Lawyers Recognizes Richard Serpe & Cindra Dowd
    Best Lawyers in America© has recognized both Richard Serpe and Cindra Dowd  in their 2021 edition. The prestigious honor recognizes the nation's very best legal professionals. Founded in 1981, Best
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