The False Claims Act (31 U.S.C. Sections 3729-33) allows a private individual or “whistleblower”, with knowledge of past or present fraud on the federal government, to sue on behalf of the government to recover stiff civil penalties and triple damages. Whistleblowers are generally individuals with inside knowledge of Securities and Exchange Commission (“SEC”) or U.S. Commodities Futures Trading Commission (“CFTC”) violations or fraud involving health care, military, or other government spending programs.

A whistleblower can be anyone with knowledge of fraud by an employer or other business.  A whistleblower suit brought on behalf of the government may include individuals or businesses who fail to pay the government the full amount it’s entitled, overcharging for a product or service or providing a defective product.  Examples of health care fraud may include:

• “Phantom Billing” – Billing for tests not performed;
• Performing inappropriate or unnecessary medical procedures;
• Billing Medicare/Medicaid for new equipment but providing the patient with used equipment;
• Billing Medicare/Medicaid for expensive equipment but providing the with patient cheaper equipment;
• A drug or equipment supplier completing a Certificate of Medical Necessity (CMN) instead of the physician;
• “Reflex testing” – Automatically running a test whenever the results of some other test fall within a certain range, even though the reflex test was not requested by a physician;
• “Defective Testing” – When a test or part of a test was not performed because of technical trouble (ie: insufficient or destroyed sample, machine malfunction) but is billed for anyway;
• Offering free services or supplies in exchange for your Medicare or Medicaid number;
• “Double Billing” — charging more than once for the same service, for example by billing using an individual code and again as part of an automated or bundled set of tests;
• Providing substandard nursing home care and seeking Medicare reimbursement;
• Routinely waiving patient co-payments.

As a result of the Dodd-Frank Act, the SEC and CFTC have enacted whistleblower programs that reward individuals who provide evidence of corporate fraud or other wrongdoing. CFTC also rewards employees of public accounting firms and outside auditors who report information of any violations.

Many state and federal laws have been enacted to protect whistleblowers and encourage them to report fraud.  Whistleblowers are generally entitled to a percentage of an amount the government collects in a successful action.  The amount of the whistleblower’s reward depends on many factors but will generally range from 10 to 30 percent of the government’s recovery. The False Claims Act also prohibits an employer from harassing or retaliating against an employee for attempting to uncover or report fraud on the federal government. If retaliation does occur, the whistleblower may be awarded “all relief necessary to make the employee whole,” including reinstatement, back pay, two times the amount of back pay, litigation costs, and attorney fees.

Chimicles & Tikellis will handle these cases on a contingent fee basis.  C&T will only be paid if the government recovers funds and the whistleblower is paid a reward. C&T will cover all necessary expenses and will seek reimbursement of those expenses from the defendant at the conclusion of the case.

If you or someone you know has inside knowledge of SEC or CFTC violations or knows of an individual or business cheating the government, please click here to contact us.