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Do I Have A Qui Tam Case?The answer to that question depends a great deal on how much evidence you have of actual wrongdoing, how much money the government has been cheated out of, and how quickly you get that information to the government. Below we'll follow a False Claims Act case through the evaluation process to learn how lawyers evaluate these cases, and what a prospective client might want to do. Joe's StoryJoe is a health care professional. He works for a large home care company that has branches all over the United States. His boss is a pharmacist. He discovers that the home care company he works for has been improperly delivering placebo medications to patients and profiting the difference between what the drugs cost and what the patient's insurer, and Medicare, paid. Joe first became aware of the problem when he noticed his patients weren't responding well to the medications. He talked to his boss who said it "wasn't any of his concern." Joe went to the office on a Sunday morning and went through the invoices. His company had billed patients and their insurers, including Medicare, for 2,100 doses of a drug called Atrovent, from January through August. But the company last bought enough Atrovent to make 500 doses in December, and has not purchased any additional Atrovent since that time. Joe took his concerns to the federal government, and the FBI investigated and found that Joe's boss was diluting the medications improperly. The boss was arrested. That same day new management came in and locked all the files, fired Joe, closed the office, and left town. Joe was left without a job, and without a way to make things right. He had heard of the False Claims Act and how he might be able to get up to 25% of the recovery if he filed an action against his former employer. Joe contacted a lawyer to have his case evaluated. Joe's LawyerJoe's lawyer asked Joe to bring any documents he had with him. He brought in the documents that showed that there were discrepancies between the amount of drugs ordered and the amount of drugs sold. Joe doesn't have the invoices that were sent to patients, because those invoices were generated in East Oilspill, Kentucky, where the corporate office of the home care company is. Joe's Lawyer tells him:We have to prove
In addition, Joe's lawyer tells him
Joe doesn't have invoices, but he does know the patients who received the diluted medications. He contacts them, gets their permission, and gets several copies of invoices that they or their insurers have paid. Joe now has enough to plead a relatively good case of fraud against the home care company. This is so because:
Joe's lawyer files the claim. The US Attorney appoints the FBI to investigate, and within 60 days Joe goes to a meeting with the government. In the interview, Joe notices that the US Attorney wants to know:
The DOJ lawyer tells Joe, in so many words, that his case isn't that good. Joe is worried until his lawyer tells him that this is what the DOJ always says during these meetings. Joe sits back and lets the government investigate. It is not uncommon for the litigation to take in excess of six years to complete. Slowly but surely, Joe gets on with his life...
Joe's claim is hypothetical example that hasn't happened, and is not likely to happen. But hopefully it shows you how these cases are investigated and evaluated. Not every case is a big case, and not every case is handled by the government. But of those that are, the recoveries can be quite significant. If you have any doubts about whether you have a claim, click here and examine our checklist.
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