Qui tam can be translated to “in the name of the king.” As so, qui tam lawsuits involve an individual reporting fraudulent behavior on behalf of the government. These individuals are referred to as whistleblowers or relators, and play an important role in the case.
While whistleblowers can report fraud in any industry, the healthcare industry makes up a large proportion of cases. In the past fiscal year, $5 billion worth of settlements and judgments were attributed to healthcare fraud of the total $5.6 billion the federal government reported for all qui tam cases.
Read more about what a qui tam relator in healthcare cases is, and how integral their role is for the justice system.
A qui tam relator in healthcare is someone who files substantial proof of a direct contact or entity committing fraud such as an employer, partner, corresponding facilities, or similar healthcare entities.
There are no specific roles that act as a qui tam relator in healthcare settings. It can be any relevant individual including:
Other parallel healthcare roles may also be in the position to witness medical fraud in any form. Regardless of their role in relation to the accused party, those acting as a relator must have sufficient evidence to file.
There are many different types of healthcare qui tam cases including overcharging for services not performed, misdiagnosing to increase payment, and other unethical and illegal actions. However, in all cases, a qui tam relator in healthcare will provide substantial documentation of proof to their lawyers to file a case, and serve as a witness to these alleged crimes.
Depending on the complexity of the case, a whistleblower may serve a different level of involvement ranging from no involvement if the government chooses to solely proceed in the case to adequate involvement. While their identity is typically public in later stages of the case, under certain circumstances a relator may be able to remain anonymous.
In the case of the United States ex rel. Debbie Burke v. St. Jude Medical, Inc., a patient acted as a whistleblower under the False Claims Act provision after receiving a faulty heart device knowingly provided by St Jude.
St Jude Medical Inc. was found to have failed to provide the FDA with prior evidence of injuries and deaths which would have resulted in a recall. Due to this evidence, the court ruled in the favor of Burke and the U.S government resulting in a $27 million payout with a percentage going to Burke for her role.
Burke, as a wronged patient, served as a qui tam relator to bring accountability to the entity to protect other patients from potential injury or death. It is encouraged for other patients, or employees in the healthcare industry to act accordingly to prevent further financial and physical harm.
Due to their diligence in protecting the government, those who choose to come forward as a qui tam relator in healthcare fraud cases and other False Claims Act cases have protection under the law.
The Communications Fraud Control Association (CFCA), ensures protection against “any employee, contractor or agent who is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against”. This ensures the safety of those willing to come forward against their own company or corresponding entities.
Attorneys can provide whistleblower aid for specific cases in regards to how to proceed, legal rights, and other unanswered questions to make sure relators are aware of what is expected of them.
If you are involved in a qui tam case or are considering acting as a qui tam relator in healthcare or relating industries, you should seek immediate legal counsel.
Fenton Law Group is one of the nation’s leading healthcare law firms, providing optimum legal strategies and whistleblower aid. With over 30 years of experience, the firm has proven success in navigating healthcare claims in Los Angeles, Oakland, and other surrounding communities.