What is a Qui Tam (False Claims Act) Case?

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Healthcare fraud accounts for the majority of qui tam recoveries. Common examples include:

• Upcoding and unbundling — Billing for more expensive services than those actually provided, or separating services that should be billed together at a lower rate.
• Billing for services not rendered — Charging the government for tests, visits, or treatments that never happened.
• Unnecessary medical procedures or tests — Ordering or performing services that are not medically necessary to increase reimbursement.
• Kickbacks and illegal referrals — Paying or receiving money, gifts, or other incentives to refer patients or generate business (violations of the Anti-Kickback Statute or Stark Law).
• False certifications — Submitting claims with false statements about medical necessity, credentials, or compliance.
• Pharmaceutical and medical device fraud — Off-label marketing, defective products, or improper pricing/reimbursement schemes.

This includes defense contracts, federal supply schedules, construction, and other government purchases. Common examples include:

• Bid rigging and collusion — Companies secretly coordinating to manipulate bids so a pre-determined winner gets the contract.
• Product substitution or defective products — Delivering lower-quality or non-compliant goods than what was contracted (common in defense and construction).
• False invoicing and overbilling — Submitting inflated bills or charging for goods/services never provided.
• Labor mischarging — Inflating labor hours, using unauthorized personnel, or shifting costs between contracts.
• Kickbacks and bribery — Offering or accepting payments to influence contract awards or performance.
• False statements in bidding — Misrepresenting qualifications, pricing, or compliance to win contracts.

The SEC Whistleblower Program is separate from qui tam/FCA cases. It rewards individuals who report violations of U.S. securities laws. Common examples include:

• Accounting fraud — Manipulating financial statements, hiding losses, or inflating profits to mislead investors.
• Insider trading — Trading stocks or securities based on material, non-public information.
• Market manipulation — Artificially inflating or deflating stock prices through deceptive trading or false rumors.
• Fraud in securities offerings — Misleading investors through false statements in offerings, prospectuses, or promotions (including Ponzi schemes).
• Foreign Corrupt Practices Act (FCPA) violations — Bribing foreign officials to obtain or retain business.
• Failure to disclose material information — Hiding important facts from investors in public filings or communications.

If your concern falls outside the three main sections above, our team can still help you understand your options, including connecting you with experienced legal counsel for the type of fraud you perceive.