Qui Tam Actions

The healthcare industry remains the most active area for False Claims Act litigation due to the immense volume of transactions within Medicare and Medicaid. Common violations include upcoding, which involves billing for more expensive services than were actually provided, and unbundling, where a single procedure is split into multiple billing codes to increase reimbursement. Furthermore, any violation of the Anti-Kickback Statute or the Stark Law can serve as a jurisdictional trigger for a Qui Tam lawsuit. Our firm conducts detailed evidentiary strategy sessions to identify these patterns of systemic billing fraud.

In the defense and infrastructure sectors, fraud often manifests as the intentional misrepresentation of product specifications or the inflation of labor and material costs. Contractors may use substandard materials while certifying that they meet military or federal safety standards. Because these contracts often involve multi-billion dollar expenditures, the regulatory exposure for a single violation can be immense. SJKP LLP manages the forensic audit of procurement records to identify discrepancies between contractual obligations and actual performance.

Federal research grants provided by agencies like the National Institutes of Health (NIH) or the National Science Foundation (NSF) are subject to strict compliance mandates regarding the use of funds. Misrepresenting the progress of research, falsifying data to secure future funding or using grant capital for unauthorized expenses constitutes a direct violation of the FCA. We evaluate the alignment between grant applications and actual research expenditures to determine if a recipient has knowingly misled the government to obtain federal assets.

The primary purpose of filing under seal is to protect the integrity of the government’s investigation, preventing the defendant from destroying evidence or altering records before federal agents can intervene. During this window, the relator is legally prohibited from disclosing the existence of the suit to any third party. SJKP LLP provides the authoritative oversight needed to manage this delicate phase, ensuring that all communications remain within the protected attorney-client and government privilege channels.

After receiving the relator’s evidence, the Department of Justice (DOJ) conducts an extensive review to decide whether it will intervene in the case. If the DOJ intervenes, it takes primary responsibility for litigating the claim, although the relator remains a party to the action. An intervention significantly enhances the evidentiary strategy and increases the probability of a favorable resolution. Our partners coordinate closely with federal investigators to ensure that the material evidence is presented in a manner that favors government intervention.

If the government declines to intervene, the relator has the legal right to proceed with the litigation independently. While this path involves higher costs and greater procedural risk, it also provides the relator with a larger percentage of the eventual recovery. Successfully litigating a declined case requires a firm with the resources to challenge a well-funded corporate defense team. SJKP LLP provides the practical decisiveness required to manage these independent actions, utilizing advanced forensic analysis to prove liability without direct government participation.

The statutory award for a successful relator ranges from 15 percent to 30 percent of the total amount recovered by the government. If the DOJ intervenes, the relator typically receives between 15 percent and 25 percent of the proceeds. If the relator successfully pursues a declined case, the reward is increased to between 25 percent and 30 percent. These awards are calculated based on the total settlement or judgment, which often includes treble damages and civil penalties. We assist our clients in documenting their unique contributions to the case to protect their entitlement to the highest possible percentage.

The Public Disclosure Bar prevents individuals from bringing a Qui Tam lawsuit based on information that has already been reported in the news media, administrative hearings or government reports. To bypass this bar, a relator must qualify as an "original source" who has direct and independent knowledge of the fraud. Identifying whether information constitutes a public disclosure is a complex procedural compliance task. SJKP LLP conducts a detailed jurisdictional analysis to ensure that your claim is not disqualified by prior public availability of the allegations.

The Federal False Claims Act follows a strict "first-to-file" rule, meaning that the first relator to file a meritorious complaint in federal court is the only one eligible for the statutory award. This creates a high-stakes race where even a minor delay can result in the loss of a significant payout. Our firm operates with the practical decisiveness required to vet your evidence and file your complaint with the speed and precision necessary to secure your status as the primary relator.

The FCA mandates that a defendant pay three times the actual loss sustained by the government. This treble damages provision applies even if the defendant did not intend to defraud the treasury; the government only needs to prove that the defendant acted with "reckless disregard" for the truth. This lower standard of intent makes the FCA an exceptionally powerful tool for federal prosecutors. Our firm provides the evidentiary strategy needed to either prove these damages for a relator or mitigate them through a robust corporate defense.

In addition to treble damages, a court must impose a civil penalty for every individual false claim submitted. In industries like healthcare, where a single fraudulent scheme can involve thousands of individual patient claims, these penalties can quickly escalate into the millions of dollars. The penalty amounts are adjusted periodically for inflation and currently exceed 20,000 dollars per claim. We analyze the volume of claims to provide an accurate regulatory exposure analysis for our clients.

Perhaps the most severe sanction for a government contractor is administrative debarment or exclusion from federal healthcare programs. A conviction or a significant settlement under the FCA can lead to the permanent loss of the right to do business with the United States. This "exclusion" often results in the total cessation of business operations for specialized entities. SJKP LLP advises on the collateral consequences of FCA litigation, helping clients navigate the administrative proceedings that follow a civil judgment.

Protected activity includes any investigation, testimony or assistance provided in furtherance of a False Claims Act case. To succeed in a retaliation claim, the employee must demonstrate that the employer knew of their protected activity and that this activity was a "contributing factor" in the adverse employment action. SJKP LLP performs a forensic review of internal communications and personnel files to establish this causal link with absolute precision.

An employee who proves they were retaliated against is entitled to all relief necessary to be "made whole." This specifically includes:

• Reinstatement to the same seniority status the employee would have had but for the retaliation.
• Double back pay plus interest on the unpaid wages.
• Compensation for special damages sustained as a result of the discrimination, including litigation costs and reasonable attorney fees. We aggressively pursue these remedies to ensure that whistleblowers are fully compensated for any professional or financial harm suffered during the course of their service to the government.

It is important to note that an anti-retaliation claim under Section 3730(h) is independent of the underlying fraud case. An employee can recover damages for retaliation even if the government ultimately chooses not to pursue the Qui Tam Action. This provides a critical safety net for individuals who act in good faith to report suspicious activity. SJKP LLP manages these dual-track cases, protecting the relator’s interests in both the fraud recovery and their personal employment rights.