What is qui tam in healthcare?

Qui tam is a provision under the False Claims Act that allows individuals to bring a lawsuit on behalf of the government against entities or individuals who have defrauded the government. In the context of healthcare, qui tam cases typically involve healthcare providers who have submitted fraudulent claims to government healthcare programs such as Medicare or Medicaid.

For example, a healthcare provider may be accused of billing for services that were not provided, upcoding services to receive higher reimbursements, or engaging in kickback schemes with other providers or suppliers. The individual who brings the qui tam lawsuit, known as the whistleblower or relator, can receive a portion of any monetary recovery obtained by the government as a reward for coming forward with information about the fraud.

Qui tam cases in healthcare have resulted in significant recoveries for the government, as well as for whistleblowers who have exposed fraudulent practices in the industry. These cases play a crucial role in holding healthcare providers accountable and deterring fraudulent behavior that can harm patients and taxpayers.