In common law, a writ of qui tam is a writ through which private individuals who assist a prosecution can receive for themselves all or part of the damages or financial penalties recovered by the government as a result of the prosecution. Its name is an abbreviation of the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning "[he] who sues in this matter for the king as well as for himself."
The writ fell into disuse in England and Wales following the Common Informers Act 1951 but remains current in the United States under the False Claims Act, 31 U.S.C. § 3729 et seq., which allows a private individual, or "whistleblower" (or relator), with knowledge of past or present fraud committed against the federal government to bring suit on its behalf. There are also qui tam provisions in 18 U.S.C. § 962 regarding arming vessels against friendly nations; 25 U.S.C. § 201 regarding violating Indian protection laws; 46 U.S.C. § 80103 regarding the removal of undersea treasure from the Florida coast to foreign nations; and 35 U.S.C. § 292 regarding false marking. In February 2011, the qui tam provision regarding false marking was held to be unconstitutional by a U.S. District Court, [1] and in September of that year, the enactment of the Leahy–Smith America Invents Act effectively removed qui tam remedies from § 292. [2]
The historical antecedents of qui tam statutes lie in Roman and Anglo-Saxon law. [3] Roman criminal prosecutions were typically initiated by private citizens ( delatores ) and beginning no later than the Lex Pedia , it became common for Roman criminal statutes to offer a portion of the defendant's forfeited property to the initiator of the prosecution as a reward. [3] Forerunners of qui tam actions also occurred in Anglo-Saxon England; in the year 656, Wihtred of Kent issued a decree that a Sabbath-breaker would "forfeit his healsfang, and the man who informs against him shall have half the fine, and [the profits arising from] the labour." [3]
The first qui tam statutes were enacted by the English Parliament in the fourteenth century, some 250 years after the Norman Conquest. [3] Such qui tam enforcement allowed enforcement of the legislative priorities of the king, especially in areas where and at times when such legislation "undermined local officials' interests." [3]
The 1318 Statute of York, which set uniform prices for certain consumer goods, was an early English qui tam provision. The act prohibited city and borough officers from selling the regulated commodities (specifically, "wine and victuals"), and provided for forfeiture to the king of any prohibited merchandise. [3] To ensure enforcement, the act provided that one-third of the forfeited merchandise "shall be delivered to the Party that sued the Offender, as the King's Gift. And in such Case he that will sue [for a thing so forfeited,] shall be received." [3]
More qui tam provisions were enacted over the next two centuries, rewarding informers. [3] For example, the 1328 Statute of Northampton penalized (by forfeiture and fine) the holding of fairs by lords and merchants for longer than the authorized length, and provided that "every man that will sue for our Lord the King, shall be received, and [also have] the Fourth Part of that which shall be lost at his Suit." [3] Two Statutes of Labourers, enacted in 1349 and 1350, set wage and price controls and provided for informers to seek forfeiture from the violator, or from mayors or bailiffs who failed to enforce the regulations. [3] A large number of other statutes, mostly affecting commercial regulations, also included qui tam provisions. [3]
Some qui tam statutes were targeted at ensuring the integrity of officials. For example:
In 1360, Parliament permitted informers to sue jurors who accepted bribes. Shortly thereafter, another law authorized qui tam suits if a person responsible for procuring and arranging for carriage of provisions for the King's household accepted a bribe. A 1391 statute permitted suits against mayors, sheriffs, and bailiffs who failed to implement a rule concerning measurement of grain. A 1442 statute prohibited customs officials and other public employees from engaging in businesses related to their public duties. The value of qui tam suits as a check on public officials had become so well accepted by 1444 that Parliament adopted no fewer than five such statutes in that single year. [3]
During the reign of Henry VII, qui tam enforcement was reformed to avoid abuses, such as collusive suits between defendants and informers meant to avoid punishment. [3] A 1487 statute, among other reforms, made it a crime (punishable by two years' imprisonment) to collude with a qui tam informer. [3]
The practice fell into disrepute in England in the 19th century by which time it was principally used to enforce laws related to Christian Sunday observance. It was brought to an effective end by the Common Informers Act 1951 but, in 2007, there were proposals to introduce legal provision on the U.S. model back to the United Kingdom. [4]
"Whistleblower" can mean any person who reveals misconduct by his or her employer or another business or entity. The misconduct may be in the form of breaking the law, committing fraud, or corruption. In the United States, that type of fraud may be a violation of the False Claims Act, or similar state and local laws, and a whistleblower who exposes fraud on the government may bring a qui tam lawsuit on behalf of the government and potentially receive a share of the recovery recovered by the government as a reward for bringing that action.
Whistleblower protections existed in the United States in colonial times, and were embraced by the first U.S. Congress as a way to enforce the laws when the new federal government had virtually no law enforcement officers.[ citation needed ]
The case of Richard Marven and Samuel Shaw led the Continental Congress to pass the first whistleblower law in the new United States in 1778. [5] The Continental Congress was moved to act after an incident in 1777, when the two blew the whistle and suffered severe retaliation by Esek Hopkins, the commander-in-chief of the Continental Navy. [6] The Continental Congress enacted the whistleblower protection law on July 30, 1778 by a unanimous vote. [7] The Continental Congress declared it the duty of "all persons in the service of the United States, as well as all other the inhabitants thereof" to inform the Continental Congress or proper authorities of "misconduct, frauds or misdemeanors committed by any officers in the service of these states, which may come to their knowledge." [8] [9] Congress declared that the United States would defend the two whistleblowers against a libel suit filed against them by Hopkins, resolving that "the reasonable expences of defending the said suit be defrayed by the United States" and terminated the employment of Hopkins, who had misconducted himself. [10]
The American Civil War (1861–1865) was marked by fraud on all levels, especially with regard to Union War Department contracts. Some say[ who? ] the False Claims Act came about because of bad mules. During the Civil War, unscrupulous contractors sold the Union Army, among other things, decrepit horses and mules in ill health, faulty rifles and ammunition, and rancid rations and provisions. [11]
The False Claims Act (31 U.S.C. §§ 3729 – 3733, also called the "Lincoln Law") is an American federal law that was passed on March 2, 1863 during the American Civil War, that allows people who are not affiliated with the government to file actions against federal contractors claiming fraud against the government. The law represented an effort by the government to respond to entrenched fraud in cases where the official Justice Department was reluctant to prosecute fraud cases. Importantly, a reward was offered in what is called the "qui tam" provision, which permits citizens to sue on behalf of the government and be paid a percentage of the recovery.
The law was substantially weakened in 1943 during World War II while the government rushed to sign large military procurement contracts. It was strengthened again in 1986 after a period of military expansion at a time when there were many stories of defense contractor price gouging. Since then, qui tam provisions have helped recover more than $48 billion in taxpayer money. [12]
The act of filing such actions is informally called "whistleblowing." Persons filing under the Act stand to receive a portion (usually about 15%-25%) of any recovered damages. The Act provides a legal tool to counteract fraudulent billings turned in to the federal government. Claims under the law have been filed by persons with insider knowledge of false claims which have typically involved health care, military, or other government spending programs.
The False Claims Act allows a private person, known as a "relator," to bring a lawsuit on behalf of the United States, where the private detective or other person has information that the named defendant has knowingly submitted or caused the submission of false or fraudulent claims to the United States. In order to qualify as a "relator", pursuant to the Supreme Court's decision in Rockwell International Corp. v. United States, in order to bring an action that is based upon publicly disclosed information the person bringing the claim must legally qualify as an "original source."
The relator need not have been personally harmed by the defendant's conduct; instead, the relator is recognized as receiving legal standing to sue by way of a "partial assignment" to the relator of the injury to the government caused by the alleged fraud. [13] The information must not be public knowledge, unless the relator qualifies as an "original source." [14]
The False Claims Act provides incentive to relators by granting them between 15% and 25% of any award or settlement amount. [15] In addition, the statute provides an award of the relator's attorneys' fees, making qui tam actions a popular topic for the plaintiff's bar. An individual bringing suit pro se — that is, without the representation of a lawyer — may not bring a qui tam action under the False Claims Act. [16]
Once a relator brings suit on behalf of the government, the Department of Justice, in conjunction with a U.S. Attorney for the district in which the suit was filed, have the option to intervene in the suit. If the government does intervene, it will notify the company or person being sued that a claim has been filed. Qui tam actions are filed under seal, which has to be partially lifted by the court to allow this type of disclosure. The seal prohibits the defendant from disclosing even the mere existence of the case to anyone, including its shareholders, a fact which may cause conflicts with the defendant's obligation under Securities & Exchange Commission or stock exchange regulations that require it to disclose lawsuits that could materially affect stock prices. The government may subsequently, without disclosing the identity of the plaintiff or any of the facts, begin taking discovery from the defendant.
If the government does not decide to participate in a qui tam action, the relator may proceed alone without the Department of Justice, though such cases historically have a much lower success rate. Relators who do prevail in such cases may potentially receive a higher relator's share, to a maximum of 30%. [15] It is conventionally thought that the government chooses legal matters it would prosecute because the government would only want to get involved in what it believes are winning cases. [17]
It is an offense under 35 U.S.C. § 292 (the "False Marking Statute") to falsely mark goods as "patented" or "patent pending". Before the enactment of the America Invents Act, any person could sue for breach, and the penalty of up to $500 was shared between the government and the person suing. Frequently, patentees fail to remove patent markings from their products following the expiration date of their patents and continue to mark goods sold after that date as patented. This behavior was largely overlooked until a court held that a separate penalty was due for each such article sold. [18]
In 2011, the United States District Court for the Northern District of Ohio held that the False Marking Statute was unconstitutional. Judge Dan Aaron Polster determined that it violated the Take Care Clause of Article II of the Constitution, because it represented "a wholesale delegation of criminal law enforcement power to private entities with no control exercised by the Department of Justice". [1]
The America Invents Act made significant changes to false marking laws, that affected all pending and future false marking actions: [2]
In the provinces of Canada that observed the English common law, the qui tam action has had limited scope, although as recently as 1933 the Exchequer Court Act, R.S.C. 1927, c. 34 had language to the effect that qui tam was permitted in "suits for penalties or forfeiture as where the suit is on behalf of the Crown alone." (Bank of Montreal v. Royal Bank of Canada, [1933] SCR 311; see sec 75(a) of RSC 1886 v2 c.135 "Supreme and Exchequer Courts"). Lawyers have used the qui tam action to prevent unwarranted intrusion into their domain by unqualified practitioners (1871: Allen Qui Tam v. Jarvis, 32 UCR 56). In cases like these, it would appear that the Crown is owed a bond from qualified practitioners, and the respondents — since they have not provided such a bond — are penalised by the courts. Allen in this case would seem to gain a fraction of the penalty exacted from Jarvis, the balance to the Crown.
'Whistleblower' can mean any person who reveals misconduct by his or her employer or another business or entity. The misconduct may be in the form of breaking the law, committing fraud, or corruption. In the United States, that type of fraud may be a violation of the False Claims Act, or similar state and local laws, and a whistleblower who exposes fraud on the government may bring a qui tam lawsuit on behalf of the government and potentially receive a share of the recovery recovered by the government as a reward for bringing that action.
In order for a whistleblower (also known as a "relator" in the context of the FCA) to bring a qui tam action that is based upon publicly disclosed information, that person must legally qualify as an "original source." See Rockwell International Corp. v. United States .
The False Claims Act of 1863 (FCA) is an American federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government's primary litigation tool in combating fraud against the government. The law includes a qui tam provision that allows people who are not affiliated with the government, called "relators" under the law, to file actions on behalf of the government. This is informally called "whistleblowing", especially when the relator is employed by the organization accused in the suit. Persons filing actions under the Act stand to receive a portion of any recovered damages.
Valdecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used in the treatment of osteoarthritis, rheumatoid arthritis, and painful menstruation and menstrual symptoms. It is a selective cyclooxygenase-2 inhibitor. It was patented in 1995.
Omnicare is an American company working in the health-care industry. It was established in April 1981 as a spinoff of healthcare businesses from Chemed and W. R. Grace and Company. It is currently a pharmacy specializing in nursing homes. In 2015, Omnicare was acquired by CVS Health.
Halifax Health is a system of hospitals and professional centers in Volusia and Flagler counties in the U.S. state of Florida. It was established in 1928.
In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.
The ethics involved within pharmaceutical sales is built from the organizational ethics, which is a matter of system compliance, accountability and culture. Organizational ethics are used when developing the marketing and sales strategy to both the public and the healthcare profession of the strategy. Organizational ethics are best demonstrated through acts of fairness, compassion, integrity, honor, and responsibility.
David Franklin is an American microbiologist and former fellow of Harvard Medical School who while employed by Parke-Davis filed the 1996 whistleblower lawsuit exposing their illegal promotion of Neurontin (gabapentin) for off-label uses. Franklin's suit, filed on behalf of the citizens of the United States under the qui tam provisions of US federal and state law, uncovered illegal pharmaceutical industry practices and created new legal precedent that resulted in a cascade of criminal convictions and civil and criminal penalties against Pfizer and several other pharmaceutical companies totalling more than $7 billion. Civil cases also followed Franklin v. Parke-Davis. Insurance companies, led by Kaiser Permanente, sued Pfizer for fraud and violation of the federal Racketeer Influenced and Corrupt Organizations Act; the Kaiser case settled in April 2014 after Pfizer's appeal at the US Supreme Court was rejected. Franklin v. Pfizer also spawned more than a thousand wrongful death (suicide) suits associated with use of Neurontin. Numerous books have addressed the social, economic and healthcare implications of Dr. Franklin's stance and actions. The settlement was the first off-label promotion settlement under the False Claims Act.
James Hoyer, P.A. is a Tampa, Florida-based law firm that focuses on whistleblower cases as well as consumer class action lawsuits. In 2015, the firm was named Whistleblower Lawyers of the Year by the Taxpayers Against Fraud Education Fund.
Shasta Regional Medical Center, formerly known as Redding Medical Center and Memorial Hospital, is a general acute care hospital that is located in Redding, California. It opened in 1945 and currently has 226 beds with a basic emergency department.
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).
Stefan Philip Kruszewski is an American clinical and forensic psychiatrist, active as a whistleblower in medically related cases. He is principal in the company which bears his name, Stefan P. Kruszewski, M.D. & Associates, P.C. in Harrisburg, Pennsylvania.
Pharmaceutical fraud is when pharmaceutical companies engage in illegal, fraudulent activities to the detriment of patients and/or insurers. Examples include counterfeit drugs that do not contain the active ingredient, false claims in packaging and marketing, suppression of negative information regarding the efficacy or safety of the drug, and violating pricing regulations.
United States v. GlaxoSmithKline was a case before the United States District Court for the Eastern District of Pennsylvania. Robert J. Merena was one of the first who filed claims against SmithKline Beecham Clinical Laboratories on November 12, 1993. The complaints alleged that GlaxoSmithKline, which operated a system of clinical laboratories, adopted myriad complicated procedures for the purpose of defrauding state and federal healthcare programs, in particular Medicare and Medicaid. The U.S. Justice Department publicly praised Robert Merena for his "cooperation and support" in helping the government collect the largest settlement ever involving a whistle-blower lawsuit. The SmithKline settlement is considered to be one of the largest whistleblower assisted recoveries in the history of the United States.
Franklin v. Parke-Davis is a lawsuit filed in 1996 against Parke-Davis, a division of Warner-Lambert Company, and eventually against Pfizer under the qui tam provisions of the False Claims Act. The suit was commenced by David Franklin, a microbiologist hired in the spring of 1996 in a sales capacity at Parke-Davis, a pharmaceutical subsidiary of Warner-Lambert. In denying the defendants' motion for summary judgment, the court for the first time recognized off-label promotion of drugs could cause Medicaid to pay for prescriptions that were not reimbursable, triggering False Claims Act liability. The case was also significant in exposing the degree to which publication bias impacts the randomized controlled studies conducted by pharmaceutical companies to test the efficacy of their products. Ultimately, the parties reached a settlement agreement of $430 million to resolve all civil claims and criminal charges stemming from the qui tam complaint. At the time of the settlement in May 2004, it represented one of the largest False Claims Act recoveries against a pharmaceutical company in U.S. history, and was the first off-label promotion settlement under the False Claims Act.
Reuben A. Guttman, born 1959 in New York City, is an American attorney and a founding Partner of Guttman, Buschner & Brooks PLLC ("GBB"), a DC-based plaintiffs' firm His practice involves complex litigation and class actions. He has served as counsel in some of the largest recoveries under the False Claims Act. The International Business Times has called Guttman "one of the world's most prominent whistleblower attorneys," and he has been recognized as a Washingtonian Top Lawyer by Washingtonian Magazine.
IPC Healthcare, previously known as IPC The Hospitalist Company, was a publicly traded corporation which operates a national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 1,900 facilities in 28 states across the U.S. The company name is derived from an earlier company called In-Patient Consultants Management, Inc. and the NASDAQ ticker name was changed to IPCM in 2008. The company changed its name to IPC Healthcare in January 2015. The company was acquired by TeamHealth in 2015 for $1.6 billion.
Rajendra Bothra is an American surgeon, humanitarian and politician of Indian origin. He is a former Chief of Surgery at the Holy Cross Hospital, Detroit and practices interventional pain management at the Pain Centre USA, Warren. He is a Fellow of the American Board of Interventional Pain Physicians (ABIPP) and is associated with Indian health organizations in conducting lectures to raise awareness of HIV/AIDS and substance abuse. He is politically aligned with the Republican Party and was appointed by George H. W. Bush as the co-chairman of the Asian-American Coalition for the 1988 United States presidential election. He was awarded the fourth highest civilian award of the Padma Shri, by the Government of India, in 1999.
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