Asked Nov 26, 2019

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?


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...

Want to see the full answer?

See Solution

Check out a sample Q&A here.

Want to see this answer and more?

Solutions are written by subject experts who are available 24/7. Questions are typically answered within 1 hour.*

See Solution
*Response times may vary by subject and question.
Tagged in


Operations Management


Related Operations Management Q&A

Find answers to questions asked by student like you
Show more Q&A

Q: I need a detailed assistance to solve this problem in: Operations Analysis. #4) A greengrocer has ex...

A: Compute the space consumed by Lettuce: 


Q: The local supermarket buys lettuce each day to ensure really fresh produce. Each morning any lettuce...

A: Given information:Price of lettuce (P) = $11 per boxSelling Price of lettuce (SP) = $25 per boxSelli...


Q: How should a U.S  firm that currency exports only to ASEAN countries respond to the creation of a si...

A: ASEAN sometimes Association of Southeast Asian Nations. It is a group of 10 southeast Asian countrie...


Q: Give an example of how the "internet of things" has been applied to the field of logistics.

A: Internet of things (IoT):IoT can be termed as an ecosystem of physical objects that are connected to...


Q: There is very high level of performance ambiguity in firms pursuing a ________ strategy compared to ...

A: Performance ambiguity:Performance ambiguity would incur when the sources for the bad performance of ...


Q: I need a detailed assistance to solve this problem: The Mantell Company makes softballs and baseball...

A: Given information:ItemSoft ball requirementBaseball RequirementAvailable ResourceLeather6ounces4ounc...


Q: 30

A: Assuming an EOQ model the total holding (or carrying cost) is given by the formula:Total holding cos...


Q: How do perceptions of employee-benefits plans influence organizational justice and organizational ci...

A: 1) perception of benefits power the perception of distributive shape justice.It's far associated wit...


Q: Case Study: Managing Employee Benefits: Strategic Benefits Planning at Makers Craft Makers Crafts...

A: Part AMakers crafts is a leader in the crafts business. Easy Crafts, a new company of this field giv...