Many potential clients come to us with concerns about fraud committed against government programs after they have already left the employer who committed the fraud or after they have been fired for bringing fraud concerns to the attention of Supervisors, Compliance Departments or Human Resources Departments.  While many of these individuals have important information about fraudulent conduct, proof is a major issue in Qui Tam cases, and the absence of documentary proof often makes it extremely difficult to prevail in such a case.

Documents that prove the fraud are often essential to mounting a whistleblower case.  This is especially true in cases involving health care fraud, where the courts require proof of specific false claims, with patient names, dates and proof that a federal health care program has been wrongly billed. Even in a case that alleges fraud under a government contract, a copy of the contract, the Request for Proposal (RFP), the employer’s submission to the government agency seeking the RFP and invoices submitted under the contract can be key to proving bid rigging, inflated costs, or time sheet fraud.

The intervention of the United States Government in a case is often key to resolving a Qui Tam case. The stronger the case – which is directly related to the quantity of documents a whistleblower is able to produce to prove the fraud – the more likely it is that the Department of Justice (“DOJ”) will intervene in the case.  The DOJ’s intervention usually leads to a settlement – 95% of the DOJ’s cases settle, according to recent statistics.  In fact, the DOJ only intervenes in about 20% of the whistleblower cases filed every year.  It makes sense that those are the cases that have the strongest initial presentation by the whistleblower.

Many of our potential clients have reported fraud internally, in the hope of putting a stop to such fraud, only to find themselves fired, demoted, or the victim of retaliation at work.  These individuals may seek help in filing a whistleblower retaliation claim, only to find that they cannot do so, because they have not also preserved important communications about their internal complaint or have not made the complaint in the right way. Certain “buzz words” can be used to alert an employer to the fact that a complaint is not just about a violation of internal company policies or an internal code of conduct, but also about fraud on a government agency or health care benefit program.

If you think you have uncovered at your company wrongful conduct that increases the cost to the Federal government under a Federal program, the very first thing you should do is to contact Ashcraft & Gerel’s whistleblower group for a confidential consultation with a Qui Tam lawyer.  We can help you – at not cost to you – decide whether you have a legitimate claim, how you can lawfully obtain documents to help you prove that claim, and whether and how you can bring that claim to the attention of your employer without undermining your job or the whistleblower law suit you may want to bring.  If you talk through these issues with an experienced lawyer before you take any action on your own, you will be able to protect yourself and better preserve your claim.  There is absolutely no down-side to such a consultation: your concerns will be kept completely confidential, and you will be the one to decide, with help from one of our experienced lawyers, what you want done with the information you provide.

There are some important things to keep in mind if you think you have discovered fraud:

What documentary evidence exists of the fraud?

Evidence of fraud can be found in emails, meeting agendas, training courses, corporate conference calls, customer call notes, invoices, contract submissions, financial records, internal memos, etc. The variety of documents is so broad that it is impossible to describe all of them.  If you come across such documents in the regular course of your employment, keep in mind that they will be vital in the event you decide to bring a lawsuit or make a complaint within your company.

What if you do not have access to documents?

Many individuals have successfully mounted whistleblower law suits by keeping journals or writing notes or memoranda detailing instances of fraud. Examples have included journal entries, notes or memos about discussions with supervisors in which they were told to falsify time or other billing records or meetings at which the fraudulent scheme was discussed. Keeping a journal or making detailed notes will help you remember key events and make your presentation more convincing.

What if your case involves health care fraud in which there may be protected patient records?

You should talk to a whistleblower lawyer about the circumstances under which you can lawfully obtain protected patient records to help report a health care fraud scheme to State or Federal authorities.

Should you talk to anyone in the company about the fraud?

This is a question on which it is extremely important that you consult with an attorney in advance.  If you decide to bring the fraud to the attention of management at your company, you will need to be certain that you do so in a way that protects you under federal and state whistleblower retaliation laws.

Resist the temptation to discuss your plans to bring a whistleblower case with friends at work. Not only is there a chance that they will talk to management about your plans, but there is also a possibility that they will decide to retain an attorney and file suit on their own, which could then make it difficult for you to bring your own case.

As you can see from this discussion, speaking with an attorney promptly after discovering fraud costs nothing, is completely confidential and will help you to protect yourself and build the strongest possible case. Our lawyers are available by telephone or by written submission. Feel free to email us, complete and submit the form on the left side of this page or call us at 301-459-8400 or toll free 1-888-221-6529. If you call, please ask for Jamie Bennett or Melissa Roover.