1. HEALTHCARE FRAUD AND FALSE CLAIMS
   • Services Not Rendered
   • Ghost Patients
   • Healthcare Kickbacks
   • Up-Coding Services
   • Bundling and Unbundling of Services
   • Lack of Medical Necessity
   • False Certification
   • Research Grant Fraud
   • Improper Financial Interest
   • Inflated Cost Reports
   • Red-Lining
   • Medicare Part D Fraud
2. PHARMACEUTICAL FRAUD
   • Off-Label Marketing of Drugs
   • Kickbacks by Pharmaceutical Manufacturers
   • Inflating the Price of Pharmaceuticals
   • Best Price Fraud
   • Pharmacy Benefit Managers Fraud
     
3. RESEARCH FRAUD
   • Falsifying a grant application in order to secure a grant
   • Falsifying research data and results
   • Over-charging time, costs and other expenses associated with the grant
   • Falsifying purchase orders for equipment and materials
   • Using grant money for other unrelated research
   • Using grant money for personal expenses
   • Improper conflicts of interest by the principal investigators
   • Falsifying progress reports and other documentation
   • Failing to comply with applicable government safety and other regulations
4. DEFENSE CONTRACTOR FRAUD
   • Cross-Charging
   • Improper Product Substitution
   • Cost-Plus Fraud (Improper Cost Allocation)
   • Worthless or Substandard Products or Services
   • Violations of the Truth-In-Negotiations Act (TINA)(requires defense contractors to honestly disclose all relevant information about its costs to the government in these types of single-source, no-bid contracts).
5. ENERGY FRAUD AND FALSE CLAIMS
   • Oil, Gas and Coal Lease Royalty Fraud
   • Energy Contracting/Services Fraud
   • Research Grant Fraud
6. GENERAL SUPPLY FRAUD
   • Defective or ineffective products
   • Selling goods in violation of Buy American Act or Trade Agreements Act
   • Best Pricing Fraud
7. CONSTRUCTION AND PROCUREMENT FRAUD
   • Bid-Rigging
   • Falsifying Minority Contractor Status
   • Kickbacks and Bribes
   • Overcharging on Materials or Labor Cost
   • Substandard Materials
   • Substandard Workmanship
   • Failing to follow contract specifications
   • Falsified Progress Reports and Documents
   • Violations Davis Bacon – best prevailing wage laws
8. UNDERPAYING THE GOVERNMENT
   • Customs or duty fraud
   • Under payment of royalties
   • Failure to return overpayments

1. Consult an Experienced Whistleblower Attorney.
   A whistleblower must be represented by an attorney in order to bring a False Claims Act case. However, not every lawyer has the experience necessary to represent a potential whistleblower. Because False Claims Act cases are complex and procedurally different than an ordinary lawsuit, the whistleblower needs an experienced whistleblower lawyer who can assist the whistleblower in navigating the inner workings of government to bring the fraud to the attention of those in a position to take action. An experienced whistleblower lawyer will also act to protect the whistleblower’s rights not to be retaliated against if the whistleblower is demoted, has pay cut or is fired because of any efforts to expose the fraud, and will file any retaliation claims that may be related to the whistleblowing. Before a whistleblower decides on taking any action, the whistleblower should seek the advice of experienced whistleblower attorneys.
2. File a Complaint and Disclosure Statement under seal–but not on the defendant.
   If the whistleblower and the whistleblower lawyer decide to bring a False Claims Act case, the whistleblower lawyer will follow procedures that are different than those used for most lawsuits. Under the federal False Claim Act, the whistleblower’s complaint is filed under seal and served on the government, but not the defendant. The whistleblower and the whistleblower lawyer will also prepare a written statement called a Disclosure Statement which the whistleblower lawyer will serve on the government lawyers who will investigate the claims. The Disclosure Statement describes the basis of the fraud and identifies all information the whistleblower has that supports the claims of fraud. It serves as a kind of road map for the government in understanding how the fraud has been committed.The Complaint and the Disclosure Statement are served on the Attorney General of the United States and the local United States Attorney. While the complaint is under seal, only the whistleblower, the whistleblower lawyer, the government and the court know that the case exists. Neither the defendants nor the public will know the Complaint has been filed. The Complaint remains under seal for sixty (60) days while the government investigates the case. However, the seal is frequently extended for months and sometimes years because of the time it takes for the government to investigate the claims. While the case is under seal, government lawyers and federal agents will meet with the whistleblower and the whistleblower’s lawyer, request documents from the agency that is alleged to have been defrauded, issue demands for documents and possibly subpoenas and search warrants to the defendant, interview witnesses, and review all the documents produced in order to verify the whistleblower’s report of fraud.
3. Government Intervention
   Before the whistleblower’s False Claim Act Complaint becomes public, the government will inform the whistleblower and the Court whether it will take over the case, or “intervene.” If the government intervenes, it takes over primary responsibility for litigating the case against the defendant. However, intervention by the government does not mean that the whistleblower and the whistleblower lawyer will not play an active role in the case. In fact, it is typical for the whistleblower and the whistleblower lawyer to remain actively involved in the case, working closely with the government to prosecute the case.If the government declines to intervene, the whistleblower case is not over. The government cannot possibly intervene in every case, and the False Claims Act specifically contemplated that the government could choose not to intervene and allow the whistleblower and the whistleblower lawyer to pursue the case in the name of the government. In reality, the government chooses not to intervene for a variety of reasons unrelated to the merits of the case, including limited government resources and confidence in the whistleblower’s lawyers. In fact, the law provides the whistleblower with a greater percentage of any recovery if the whistleblower moves forward after the government does not intervene. The increased incentive for the whistleblower to proceed without the government is a clear indicator that Congress wants whistleblowers to continue with their meritorious cases even if the government cannot intervene. Sometimes the government will decline to intervene and watch the case as the whistleblower lawyers move the case forward. When that happens, the government can still come back into the case and take it over even though it initially declined to intervene.If the whistleblower and the whistleblower lawyer decide to continue to prosecute the case on behalf of the government after the government chooses not to intervene, the case proceeds like most other civil lawsuits pending in federal court.

Today, nearly 150 years later, the False Claims Act remains one of the federal government’s most effective weapons in fighting fraud against the government. The False Claim Act provides whistleblowers, or Relators as they are known, financial compensation in the form of a percentage of the amount the government recovers in the successful case the whistleblower brings to them. [can you hyperlink to the whistleblower reward page?] and includes protections against unlawful workplace retaliation for exposing the unlawful activity. According to the False Claims Act, a false claim is defined as “any request or demand presented to an officer, employee, or agent of the United States; or made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government’s behalf or to advance a Government program or interest, and if the United State Government pays the claim or any portion of the claim or will reimburse the contractor or the entity who received any portion of the money or property which is requested or demanded.” 31 USCA § 3729. Many states, including California, have followed the federal government in adopting state whistleblower statutes to combat fraud against state and local governments as well.

Using these laws whistleblowers may be able to assist the federal or state government in recovering funds from individuals or entities that knowingly submitted false claims to the United States government or one of the state governments through qui tam lawsuits.

In 2011 the federal government opened new whistleblower programs to help protect shareholders and other investors against securities and commodities trading related frauds under the new Dodd-Frank Act. [can you then hyperlink here to the what is a Dodd Frank whistleblower page?] These new whistleblower programs will help protect shareholders specifically, but more generally will help insure the integrity of our financial markets.

These are only a few of the laws that may apply when someone looks to blow the whistle on corporate wrongdoing.Before blowing the whistle on fraud or on other corporate misdeeds, seek the advice of whistleblower lawyers who know and understand the laws that apply to these cases. Contact the whistleblower attorneys at Keller Grover LLP.

• What does the whistleblower know?
  Does the whistleblower have actual knowledge of the fraud? Suspicion is not enough. It is helpful in fraud cases if the whistleblower has first-hand information of the “who, what, when and where” of the fraud. A potential whistleblower should expect to be asked these questions, and be prepared to answer them, in evaluating what the whistleblower actually knows. The more details the whistleblower has surrounding the fraud, the more likely it is that the whistleblower has evidence with which to bring a case.
• Have the facts of the fraud that would form the basis of the lawsuit already been publicly disclosed?
  If the facts of the fraud that would form the basis of the whistleblower’s lawsuit have been publicly disclosed the whistleblower’s False Claims Act case will be prohibited, unless the whistleblower can establish that he or she is the “original source” of information upon which the claims are based. Public disclosure includes information disclosed in newspapers, magazines, TV shows, internet, radio, court records, administrative hearings, Congressional hearings, responses to FOIA requests or U.S. General Accounting Office reports.To qualify as an “original source” the whistleblower must have voluntarily disclosed to the government what the whistleblower knew before the public disclosure. A whistleblower can also qualify as the “original source” if the whistleblower has knowledge that is independent of and materially adds to the publicly disclosed allegations or transactions, and the whistleblower has voluntarily provided the information to the Government before filing a False Claims Act case.
• Has the government been defrauded?
  Federal funds must be involved, or, in a state with a state False Claims Acts, state funds must be involved.
• Did the company or individual intend to commit the fraud?
  The company or entity that submitted the false claim to the government must have done so with intent to defraud. If the company or entity submitted the claim with knowledge that the claim was false or misleading, this is good evidence of intent. Further, if the company or individual should have known the claim was false but ignored red flags or reports of the falsity or misleading nature of the claim, then the conduct may also be considered intentional. However, if the company or entity acted in good faith or just made bad management decisions, the conduct may not be a violation of the False Claims Act. Proving intent is rarely easy and evidence of intent will vary from case to case. While a whistleblower may not initially possess all the evidence needed to prove intent, the whistleblower should at least be able to explain why the conduct was not in good faith or just a bad business decision and present any documents which will go towards proving intent.

In addition to the reward provisions, the whistleblower laws also have provisions that allow whistleblowers to bring claims for their own damages against employers who retaliate against or harass the whistleblower for exposing wrongdoing. By providing remedies to help whistleblowers recover for what they may lose as the victims of retaliation, these laws encourage employees to come forward knowing that they can enforce their own rights and look out for their own best interests as well. Whistleblowers who have been fired in retaliation for reporting corporate wrongdoing may sue to be reinstated, for back pay, and for special injuries stemming from the retaliation. If you have been retaliated against for blowing the whistle in the workplace, you should immediately contact a whistleblower lawyer. The qui tam lawyers at Keller Grover LLP know how to expose fraud using the whistleblower laws and work hard to recover the maximum amount possible for their clients in these whistleblower actions.

Any person who wishes to pursue a whistleblower lawsuit and any person who has been retaliated against for reporting wrongful conduct should contact the whistleblower attorneys at Keller Grover LLP for more information.

Thankfully, Congress anticipated that a whistleblower may face retaliation and wrote a section of the False Claims Act to address the countless ways it might occur. If the whistleblower does face retaliation relating to the whistleblower’s efforts to expose violations of law – either before bringing the case, while the case is proceeding, or after it is completed, the whistleblower may state a separate claim for retaliation. The False Claims Act section addressing the whistleblower’s retaliation claims says, “Any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment because of lawful acts done by the employee, contractor, agent or associated others” relating to whistleblowing activity.

If a defendant is found to have retaliated against a whistleblower in violation of the False Claims Act, the whistleblower may be entitled to reinstatement with the same seniority status, double the amount of back pay, interest on the back pay, and compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys’ fees. This claim, and any damages recovered under this provision of the False Claims Act, belong to the whistleblower and are not a claim on behalf of the government like the qui tam claim the whistleblower might bring to help recover money improperly taken from the government.

Because the facts surrounding the whistleblower’s potential retaliation claim are so often connected to the facts which make up the fraud on the government, the whistleblower needs qualified and experienced attorneys to help develop a strategy that addresses both the fraud on the government and any retaliation against the whistleblower. Before a whistleblower decides on taking any action, the whistleblower should seek the advice of experienced whistleblower attorneys who can assist the whistleblower in bringing the fraud to the attention of those who can put a stop to it and protect the whistleblower’s rights in the event of any retaliation.

A “claim” is defined under the FCA, 31 USC § 3729, as:

“any request or demand, whether under a contract or otherwise, for money or property and whether or not the United States has title to the money or property, that (i) is presented to an officer, employee, or agent of the United States; or (ii) is made to a contractor, grantee, or other recipient, if the money or property is to be spent or used on the Government’s behalf or to advance a Government program or interest, and if the United States Government (1) provides or has provided any portion of the money or property requested or demanded; or (2) will reimburse such contractor, grantee, or other recipient for any portion of the money or property which is requested or demanded.

The definition of “claim” was amended in 1986. The amendment expanded the scope of the types of transactions that could constitute a “claim” made against the government. Under the amendment, a “claim” is any request or demand of money from the Government, made directly or made through a third party (intermediary), including a contractor, grantee, or other recipient of federal funds. A “claim” may also be shown if the conduct prevented the government from being paid money due. At the heart of defining a “claim” is Congress’ intent that the FCA to apply to all fraudulent attempts to cause the Government to pay money on its own behalf or attempts to deny the government from money that it is due.

If the government declines to intervene, the whistleblower case is not over. The government cannot possibly intervene in every case, and the False Claims Act specifically contemplated that the government could choose not to intervene and allow the whistleblower and the whistleblower lawyer to pursue the case in the name of the government. In reality, the government chooses not to intervene for a variety of reasons unrelated to the merits of the case, including limited government resources and confidence in the whistleblower’s lawyers. In fact, the law provides the whistleblower with a greater percentage of any recovery if the whistleblower moves forward after the government does not intervene. The increased incentive for the whistleblower to proceed without the government is a clear indicator that Congress wants whistleblowers to continue with their meritorious cases even if the government cannot intervene. Sometimes the government will decline to intervene and watch the case as the whistleblower lawyers move the case forward. When that happens, the government can still come back into the case and take it over even though it initially declined to intervene.

If the whistleblower and the whistleblower lawyer decide to continue to prosecute the case on behalf of the government after the government chooses not to intervene, the case proceeds like most other civil lawsuits pending in federal court.

The 2010 Amendments to the False Claims Act gave the federal government final say as to whether the court may dismiss based on the public disclosure bar, ensuring that whistleblowers with firsthand, non-public information are able to move forward with their claims.

The term Dodd Frank whistleblower has started to appear in the news but most Americans don’t yet realize how the Dodd Frank whistleblower laws may help in the fight against frauds that impact every American. In the wake of the financial crisis of 2008, Congress passed the “Dodd-Frank Wall Street Reform and Consumer Protection Act.” A key component of this new law is the creation of new whistleblower programs. The Dodd-Frank Act created new whistleblower programs at the Securities and Exchange Commission (SEC) and at the Commodities Futures Trading Commission (CFTC) that opened in 2011 when the new regulations enforcing the law took effect.

Congress created this new whistleblower law to encourage individuals to come forward to either the SEC or the CFTC with information about violations of the federal securities or commodities trading laws. The assistance provided by whistleblowers who know of violations of these federal laws is invaluable to the federal government in its ongoing effort to identify these frauds and help prevent new ones in the future. With the help of whistleblowers, the federal government can reduce the risk of harm to investors, assure confidence in the integrity of U.S. financial markets, and hold those engaging in fraud accountable for their violations.

Under the new whistleblower law, eligible whistleblowers are rewarded with between 10-30% of the monetary sanctions collected in actions brought against violators where the sanction is more than $1Million. How the percentage is decided depends on several factors. Further, like the False Claims Act, the new whistleblower law also prohibits retaliation by employers against employees who provide information about possible violations of the securities or commodities trading laws.

Significantly, the new whistleblower law does not involve filing a lawsuit in a court as happens when a whistleblower uses the False Claims Act. Under the new whistleblower law, a whistleblower, with the assistance of a whistleblower lawyer, provides confidential information to the SEC or the CFTC whistleblower office (depending on the nature of the violations being alleged). Under the new whistleblower law, only the whistleblower and the whistleblower’s lawyer know that he/she is the person providing the information to the government. Even the federal agency investigating the allegations will not know initially who the whistleblower is. This added layer of protection for a whistleblower helps reduce the risks for a whistleblower who may be wary of coming forward with information about what an individual or company is doing for fear of retaliation.

The Dodd Frank whistleblower law is a powerful new tool in fighting fraud. The government, aided by whistleblowers and their whistleblower lawyers, will be better equipped to assure that individuals and corporations abide by the law in conducting their business. If you would like more information about the Dodd-Frank Whistleblower Program and how the law will work, or if you have information about possible violations of the securities or commodities trading laws, contact the whistleblower lawyers at Keller Grover LLP who are prepared to help whistleblowers bring their Dodd-Frank whistleblower actions to the SEC or CFTC.

Medicare has several different programs.
Medicare Part A is hospital insurance and covers inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.

Medicare Part B is medical insurance that helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (“DME”) and some preventative services.

Medicare Part C is sometimes referred to as Medicare Advantage. Under a Medicare Advantage program, private insurance companies approved by the Medicare program offer benefits and services covered under Part A and Part B. They usually include some prescription drug coverage too (Part D) and may include additional benefits and services at an additional cost to the beneficiary.

Medicare Part D is the Medicare prescription drug benefit. Like Medicare Part C, it is run by private insurance companies approved by the Medicare program. It helps cover and may help lower the cost of prescription drugs.