Qui tam (whistleblower) lawsuit
A qui tam lawsuit is a civil action brought under the False Claims Act by a private person — a “relator” — on the government's behalf and in the government's name. The complaint is filed under seal so the government can investigate and decide whether to take over the case; if it declines, the relator may pursue it alone. A successful relator may receive a share of the recovery, and the False Claims Act protects whistleblowers from retaliation.
Updated
A qui tam action is the False Claims Act's whistleblower mechanism, at 31 U.S.C. § 3730(b). It lets a private person — called a relator — file a civil action “for the person and for the United States Government,” alleging that someone knowingly submitted false claims for federal money. The suit is brought in the government's name, not just the relator's own. The term is short for a Latin phrase describing one who sues for the government as well as for himself.
The procedure gives the government the first move. A qui tam complaint is filed in camera and stays under seal while the government investigates and decides whether to intervene; the defendant is not served until the court orders it. If the government intervenes it takes the lead; if it declines, the relator may proceed with the case alone.
In practice
In health care, the relator is very often a current or former employee of the billing operation — someone positioned to see the claims. If the case succeeds, the relator may receive a share of what the government recovers, and that share is set higher when the government declines to intervene and the relator carries the litigation than when the government takes the case over. The exact percentages are fixed in the statute; the shape to remember is that the law pays more to the whistleblower who does more of the work.
The False Claims Act also protects the person who reports. An employee, contractor, or agent who is discharged, demoted, or otherwise discriminated against for lawful efforts to stop a violation or advance an action is entitled to be made whole. For a practice, that makes an internal reporting channel more than good hygiene: a billing concern that is heard and acted on inside the practice is the alternative to the same concern arriving as an external qui tam suit.
Commonly confused with
- False Claims Act: The False Claims Act is the statute. Qui tam is one way it is enforced — a private relator suing on the government's behalf — alongside the Attorney General's own authority to bring an action directly.
- Reverse false claim: A reverse false claim is a theory of what is unlawful (knowingly avoiding an obligation to return money owed to the government). Qui tam is a procedural mechanism — who may bring the case — not a kind of violation. A qui tam suit can allege a reverse false claim or an ordinary one.
- Civil monetary penalty: A civil monetary penalty is imposed administratively by the HHS Office of Inspector General, outside court. A qui tam action is a civil lawsuit in federal court under the False Claims Act, enforced through the Department of Justice or by the relator.