A Qui Tam Complaint Just Landed on Your Desk: What Fort Myers Medical Practices Should Do Next
Being served with a qui tam complaint in the Middle District of Florida can feel like it came out of nowhere. It almost never did. A qui tam case is a False Claims Act lawsuit filed by a private whistleblower, often a former biller or office employee, on the government’s behalf. By the time your practice sees the paperwork, federal investigators may already know plenty about your billing.
Why You Are Only Hearing About It Now
Whistleblowers file these cases under seal. Under 31 U.S.C. § 3730(b)(2), the complaint stays hidden from the defendant while the government decides whether to take over. Once the seal lifts, the government has either stepped in or declined. A decline does not end the case, because the whistleblower can usually keep going alone.
Civil Exposure and Treble Damages
Under 31 U.S.C. § 3729(a)(1), a person who knowingly submits a false claim owes a civil penalty for each claim, plus three times the government’s damages. Across thousands of Medicare or Medicaid claims, those numbers multiply fast.
“Knowingly” is also broader than most practice owners expect. Under § 3729(b)(1), deliberate ignorance and reckless disregard count, and no specific intent to defraud is required. An unaudited coding habit can become a seven-figure problem.
Allegations aimed at medical practices often include:
- Upcoding, or billing for a more expensive service than the one provided
- Billing for services that were never performed or were not medically necessary
- Unbundling procedures that should be billed together
- Paying or receiving kickbacks for patient referrals
- Keeping overpayments after discovering them
The Risk of a Parallel Criminal Case
The same facts can support criminal charges. Health care fraud under 18 U.S.C. § 1347 carries up to 10 years in prison, with higher maximums if the conduct causes serious bodily injury or death, and prosecutors can run civil and criminal tracks at the same time. Anything your practice says in an answer, a discovery response, or a deposition may follow you into the criminal side. In some situations, a lawyer can ask the court to pause the civil case while a criminal investigation plays out.
Smart First Steps
Your response deadline is short, so move quickly and carefully:
- Preserve everything, including charts, billing data, emails, and texts. Deleting records can create an obstruction problem far worse than the original allegation.
- Send every call from investigators, the whistleblower’s attorney, or the press straight to your lawyer.
- Do not confront or punish a suspected whistleblower. 31 U.S.C. § 3730(h) protects employees from retaliation.
- Check your insurance policies for notice requirements, since late notice can jeopardize coverage.
A qui tam complaint is an accusation, not a verdict, and a measured response can shape everything that follows. Speaking with experienced Fort Myers white collar crime lawyers early lets you protect both the practice and your own personal exposure. Before your deadline arrives, bring the complaint to your Fort Myers and Naples criminal defense lawyer. Call us at Foley & Wilson Law Firm at 239-690-6080 to schedule a free consultation, and we will start with the question that matters most: where does your practice actually stand?
Source:
law.cornell.edu/uscode/text/31/3729