What are Qui Tam Lawsuits?

The federal government provides healthcare coverage for more than 100 million people every year, offering essential benefits through Medicare, Medicaid, federal employee insurance programs and military benefit programs. Over $900 billion flow annually from the federal government to healthcare providers, hospitals, long-term care facilities, nursing homes, assisted living facilities, pharmaceutical companies and medical device manufacturers to keep this system running. The opportunities for increasing profits, at the expense of patients and taxpayers, are enormous and ever-present.

A qui tam lawsuit (also called a qui tam action) is a powerful way for whistleblowers to help the government stop many kinds of fraud and recover money for the US Treasury and American taxpayers. Some of the types of fraud alleged in qui tam claims include Medicare and Medicaid fraud, defense contractor fraud and procurement fraud. Qui tam lawsuits have helped to recover billions that have been stolen from the US Treasury and taxpayers.

Qui tam literally means “in the name of the king” and 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.”

Qui tam is pronounced many different ways. The most common is “kee tam” (rhymes with “Sam”). Qui tam also is pronounced as “kwee tam,” or “kwee tom” (as in the name, “Tom”).

Any individual with information about fraud against the government may become a whistleblower and bring a qui tam lawsuit. This is often an employee of the company committing the fraud, but it also can be a competitor, a contractor or anyone else who has information about the fraud.

An attorney files the qui tam lawsuit on behalf of the whistleblower, who is called a “relator” in qui tam cases. The qui tam lawsuit and supporting documents should provide the government with specific information about the fraud. The qui tam law has some restrictions that prevent more than one whistleblower being rewarded for reporting the fraud and prevent qui tam lawsuits that are based on certain public information.

A qui tam lawsuit under the False Claims Act can be based on any of the following violations by an individual or entity that:

• Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval. Knowingly makes, uses or causes to be made or used, a false record or statement important to a false or fraudulent claim for payment or to an obligation to pay or transmit money or property to the government.
• Knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the government.

The False Claims Act requires that a whistleblower use an attorney to file a qui tam case. A qui tam attorney will put together a complaint that describes the violations that the whistleblower is reporting and how they violate the law.

The qui tam lawsuit is filed in federal district court “under seal,” meaning it is kept confidential so that only the government is aware of the case. The seal gives the government time to investigate the allegations and determine whether it will join the whistleblower’s case. Even the person or entity being accused of fraud is not told about the qui tam case without the court’s permission. The case only becomes public once the government decides whether to join the case.