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Heyl Royster

 

Practices

QUI TAM (WHISTLEBLOWER)

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With the federal government recouping more than $33 billion from alleged fraud perpetrators between 1986 and 2012, qui tam lawsuits filed pursuant to the False Claims Act have become increasingly popular. With the creation of the interagency task force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), and amendments to the False Claims Act, the federal government has unquestionably focused its efforts and resources on healthcare fraud. The net result has been an influx of healthcare-related qui tam lawsuits. In fact, in December of 2013, the Department of Justice reported that it collected more than $2 billion in cases involving alleged health care fraud for a fourth straight year.

Defending Qui Tam actions requires a special combination of trial skills including experience dealing with government authorities and a detailed knowledge of the client’s business. Our experienced attorneys have represented clients through every phase of qui tam proceedings under the False Claims Act. Heyl Royster’s proactive approach starts with the internal investigation and is focused on obtaining a successful result as soon as possible. Our knowledge of the intricacies that exist within the False Claims Act provides us with the background that is necessary to develop an effective defense. Our extensive experience working with federal government officials throughout the qui tam process gives our attorneys a unique insight into the framework that underlies False Claims Act investigations and intervention decisions.

Our Qui Tam Practice Group also has extensive experience in Medicare and Illinois Medicaid billing and reporting requirements, including an intimate knowledge of a hospital’s obligations under the amended False Claims Act. In addition, our attorneys have experience navigating the interplay between the Anti-Kickback Statute, Civil Monetary Penalty Statute, and Stark Law. When an entity or individual is subject to a False Claims Act investigation, our depth and experience become an immediate factor in addressing and engaging the federal government and relator’s counsel at an early stage.

Examples of Our Recent Qui Tam Representations

  • After engaging federal government officials and responding to civil investigative demands, obtained a notice of declination of intervention in a qui tam lawsuit arising out of alleged hospital upcoding.
  • Obtained a dismissal of a qui tam lawsuit and retaliatory discharge claim arising out of a hospital allegedly submitting claims for Medicare reimbursement that were not medically necessary.
  • Prepared and represented physicians for interviews with United States Department of Justice.
  • Defended retaliatory discharge claim of alleged whistleblower.
  • Defended hospital against Relator’s claim of inflated billings in violation of False Claims Act.
  • Counselled hospital regarding handling of physician threatening a False Claims Act case.

Publications

  • “Beware the Whistleblower: Whether Congress’ Omission of the Term ‘Employer’ from Section 3730(h) of the False Claims Act Was Intended to Extend Liability to a Whistleblower’s Individual Supervisors,” Illinois Defense Counsel Quarterly (2014)

  • “The Rise of the ‘Reverse’ False Claim And Proposed Rules from CMS on Reporting and Returning Overpayments,” Illinois Defense Counsel Quarterly (2013)