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in iscal year 2010 whistleblowers helped
recover almost $2.4 billion.

Lawyers have a Latin phrase for

what West did: qui tam pro domino rege
quam pro se ipso in hac parte sequitur,

or just qui tam for short. It means “he
who sues on behalf of the king as well

as for himself.” under most circum-
stances in law, as the party being

defrauded, the government would have
to sue, but thanks to the False Claims

Act, any individual having knowledge
of someone’s improperly receiving Claims Act whistleblower reward the rewards for employees, patients,

payments from the federal government [mobilizes] private individuals and and other victims who report such
may bring action.
their attorneys to do the work without fraud from 10 to 15 percent. Yet, as the

In both 2009 and 2010, Congress the need for any government pro- example of West shows, the lone indi-
strengthened the laws penalizing this grams,” she testified. “Not one dime vidual is much more likely to help gov-

fraud to make it easier and more lucra- comes from taxpayers to pay for these ernment uncover companies engaged
tive for those who see or know about it recoveries because the statute allows in cheating. As a way of comparison,

to come forward.
recovery of triple damages from the the government’s Centers for Medicare
In his statement to a Congressional fraudster so that the government can and Medicaid Services recouped only

hearing on Medicaid fraud in 2011, be made whole [as well as pay court about $15 million in 2010, or about six
West said, “Maxim was over-billing costs, attorney fees, and the whistle- tenths of 1 percent of what private ef-

and under-delivering basic services to blower’s reward].”
forts recouped.
America’s oldest, sickest, and poorest. Although Maxim’s thievery may If the government decides a qui tam

The goal was not to provide better ser- seem massive, in fiscal year 2010 case has merit, the uSDoJ will inter-
vices and products at lower prices, but whistleblowers helped recover almost vene, but the “original source” is still

rather to see if they could take advan- $2.4 billion, according to testimony in entitled to recover a share of any settle-
tage of weak Medicare and Medicaid the same hearing. In one of the largest ment. According to the uSDoJ, almost

oversight ... to see if patients who com- examples of Medicare fraud in united 95 percent of its interventions result in
plained would not be taken seriously or States history, Columbia/HCA settled a favorable judgment. under the False

would give up.”
with investigators for $1.7 billion. Here Claims Act, you must be represented by
As West pointed out, Medicare and in Tennessee, the government re- an attorney to initiate a qui tam suit.

Medicaid fraud is not only about steal- vealed this September that Vanderbilt For West, he was suing not only on
ing from the deep pockets of uncle Hospital was under investigation for behalf of the “king,” but also on behalf

Sam. This theft preys on those society alleged years of deceptive billing. Still, of all the people who needed what
has designated as needing assistance, most experts believe the great majority Maxim was stealing for its sharehold-

either from disability or age. The more of Medicare and Medicaid fraud goes ers: “When corporations rip off Medi-
a health-care provider diverts that undetected. Eighty-three percent of all care and Medicaid, there are other

assistance into its coffers, the less is civil fraud recoveries, according to the victims besides taxpayers. Maxim took
available for the intended purpose of united States Department of Justice services from people like me.”

helping the sick and aged.
(uSDoJ), are healthcare-related.
The attorney for West told Congress Consequently and in anticipation Bruce Fox has practiced law for more than 30 years and has

that the best way to stop this abuse
of the Affordable Health Care Act’s successfully represented clients at every trial and appellate
of the public trust was by incentiv- roll out, the obama administration court level of the Tennessee State Judicial System. www.

izing private persons. “Earning a False
proposed earlier this year to increase
foxandfarleylaw.com

january february 2014 cityviewmag.com 131