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Differences in Medical Opinion Under the False Claims Act

Courts have recently grappled with the issue of whether a Relator can maintain a case under the False Claims Act (“FCA”) where she retains an expert that says the medical services provided were not medically necessary and the defendant’s medical service provider or its retained expert says the exact opposite […]

Whistleblower Rewards: How They Work

The federal False Claims Act (“FCA”) allows an individual with knowledge of fraud upon the federal government, often known as a whistleblower or qui tam relator, to bring a lawsuit on the federal government’s behalf to recover the funds. Many states  have adopted similar laws that apply to fraud upon state […]

What is a Qui Tam Relator?

In False Claims Act (“FCA”) cases, the qui tam relator is the whistleblower who brings the FCA claims against the company or individual who is committing fraud. Usually a qui tam relator is an insider—typically a current or former employee—who has access to confidential information showing that his or her […]

Tennessee Whistleblower Law

The Tennessee False Claims Act  (“Tennessee FCA”) mirrors the federal False Claims Act (“FCA”), but it involves claims made to state and local governments in Tennessee, as opposed to the federal government. The Tennessee Medicaid False Claims Act (“Tennessee Medicaid FCA”) applies to any false claims made to Tennessee’s state […]

Medicaid Fraud

Medicaid pays for approximately 20% of all healthcare expenses in the United States, over $600 billion each year. Well over 500,000 healthcare providers, ranging from hospital chains to individual doctors to ambulance helicopter pilots, receive payments from Medicaid every year. Inevitably a few of the providers will try to defraud […]