Why Do Healthcare Fraud Qui Tam Laws Matter?

The following is taken from an interview with Qui Tam attorney Tony Munter as he discusses healthcare fraud laws related to qui tam and why it is important. To discuss a case or learn more consult with a qui tam healthcare fraud lawyer today.

What is qui tam? Well, it comes from a Latin phrase, a longer Latin phrase and it stands for the Latin phrase that means, “He who sues for himself as well as the king.”

And, it goes back I think to the middle ages in England where you could do that, you could essentially sue on behalf of the king. And you’re seeing this phrase so-called “qui tam action” in a lot of news reports from defense lawyers and people who don’t like the False Claims Act very much to try and make it sound really, you know, nefarious or evil, something a so-called qui tam action, try and make it sound bad.

But it’s really not bad at all, it’s a great right. It’s a right that we have as Americans to be able to sue in order to protect our country from fraud. I think it should be really celebrated. It shouldn’t, you know many people want to make it sound a little ooh what is this Latin phrase. It’s not so mysterious. It just means that we all as Americans have the right and actually anybody not even just Americans can sue when the government is defrauded by unscrupulous contractors.

Why Are So Many Qui Tam Cases Related to Healthcare Fraud?

Well, there are really two reasons for that. The first is that the government spends so much money on healthcare and is so deeply involved in it that there are tremendous opportunities to file cases just because of the sheer amount of medical money involved and medical practices.

The government spends billions on Medicare, spends money on Medicaid, spends money for government employees, TRICARE, all kinds of healthcare programs out there. So the government is involved in healthcare to a great degree and it’s a huge sector of the economy. So that provides an opportunity for whistleblowers to file False Claims Act cases (pdf) simply because there’s great potential liability when this many people charge the government for so many services.

The other reason I think though is that the government is in a better position I think to support these cases because the government doesn’t directly benefit from the service. The service is provided to all of us who need healthcare. And, so the government really isn’t in the room particularly watching how the service is being provided every two minutes. It just pays for it and that creates a much easier position for the government to pursue the claim than in some other types of contracting situations in which the government is day-to-day watching how the funds are provided and what services are being provided in exchange for the funds.

Why Do These Laws Matter?

Well, I think they matter because we have such a huge, huge amount of money going into healthcare. $600 billion in Medicare payments last year alone and we have almost no way to control the expenses involved. And a lot of people within the healthcare field are in a position to refer business to each other and drive up cost. The average person is really not in a position to know whether or not they are getting care based on what’s best for them or whether or not they’re getting care based on what’s best for a medical device manufacturer or a drug company or who knows.

So, these laws are intended to try and take those type of incentives that is to say business only type of incentives out of the healthcare system or at least punish those who provide these types of services only on a business instead of on a patient care basis, so that we, when we go to the doctor hopefully we get unbiased advice, hopefully we get informed consent as to what the appropriate care should be as to what services we should be provided as to what is medically necessary for us. That’s what we’re looking for, otherwise, we’re sort of at the mercy of a system that would make it very easy to charge for almost anything. And, so that’s the idea behind these practices.