Question
Asked Nov 26, 2019
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One key objective of the compliance plan in a healthcare organization is to create a secure and effective reporting process, thereby avoiding qui tam lawsuits against the facility. What is a qui tam lawsuit, and how can we avoid them? Can you envision any situation in which you yourself might file a qui tam lawsuit?

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Expert Answer

Step 1

Qui tam lawsuits are a kind of whistleblower lawsuit that is generated under the False Claims Act, a law that rewards whistleblowers in successful cases where the government claims funds lost to fraud. Qui tam is short for a Latin phrase, “qui tam pro domino rege quam pro se ipso in hac parte sequitur” that roughly transforms “he who brings an action for the king as well as for himself.”

Qui tam cases are a powerful structure for whistleblowers to help the government. By which the government can stop many kinds of fraud – Medicare and Medicaid fraud, defense contractor fraud and numerous other types of frauds that impact the government financially – and recover billions that have been stolen from the Treasury and taxpayers. (Tax frauds and securities law violations are handled differently.)

Step 2

Healthcare fraud cases under the False Claims Act have grown considerably in recent years.

The FCA is the government's primary civil solution to redress false claims for federal money or property. Most actions are filed under the FCA's whistleblower, or qui tam, provisions. These allow private citizens, or relators, to file suits alleging false claims on behalf of the government. If the government succeeds in the action, the whistleblower then receives a portion of the recovery.

There were 62 healthcare qui tam cases recorded from 1987 to 1992. In 2011 alone, there were 417. Another 412 were recorded in 2012, according to a study from Washington, D.C.-based Taxpayers Against Fraud.

This rate of qui tam cases is not supposed to slow down, especially since whistleblowers may have even more incentive to bring charges. In April 2013, CMS proposed a rule that would increase the incentive program for whistleblowers who provide information that leads to the recovery of improper Medicare payments. The rule would expand how much CMS can reward whistleblowers under its Medicare Incentive Reward Program, which is separate from the FCA.

Step 3

Under the Medicare Incentive Reward Program, CMS can pay whistleblowers 10 percent of the amount recovered or $1,000, whichever is less. The rule would expand that amount to 15 percent of the final recovery amount applied to up to the first $66 million recovered. This means a person could earn up to $9.9 million if CMS recovers $66 million or more from their tip.

We can avoid suc...

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