Whistleblower Terms Explained
Wondering what a “relator” is, or what “upcoding” means? It’s entirely understandable if you don’t know the specialized language of the various facets of whistleblower law. Therefore, we are supplying you with a basic glossary that contains some often-used terms, phrases, and acronyms, to help you better understand the details of whistleblower cases.
In whistleblowing, the most common use of this term involves the Medicare and Medicaid Patient Protection Act of 1987, which contains an anti-kickback statute. Kickbacks, which are illegal, are any compensation provided to expedite a transaction. Violations of an anti-kickback statute are one reason to bring a whistleblower suit.
Commodity Futures Trading Commission (CFTC)
The CFTC regulates the markets in commodities (such as sugar, gold, or oil) as well as the financial futures and options markets. It is an independent agency of the U.S. government.
A Securities and Exchange Commission (SEC) term. A covered action means a legal action which results in monetary sanctions greater than $1 million in an SEC whistleblower case.
When a qui tam whistleblower case is declined, it means the government has decided, after an investigation, not to join the whistleblower in pursuing the legal action. The whistleblower has the option to continue the case on their own. See Intervened Case.
This Act reformed the U.S. regulatory system for our financial sphere. It includes greater incentives and protections for any whistleblower that brings a case to the SEC involving securities and financial violations. The Dodd-Frank Act allows a successful whistleblower to be awarded between 10 and 30 percent of any recovered funds.
False Claims Act (Federal)
Also known as the Whistleblower Act and Lincoln Law (for President Lincoln who signed the first version of it), the federal False Claims Act allows a successful whistleblower to be awarded between 15 and 30 percent of any recovered funds. The Act also offers whistleblowers certain legal protections and has undergone a number of changes over the years. The most recent round of amendments was in 2009. There are some states with their own false claims acts.
When the government intervenes in a qui tam whistleblower case, it means the government has decided, after an investigation, to join the case and be the primary party that pursues the legal action. See Declined Case.
The U.S. Food and Drug Administration (FDA) approves only certain uses for drugs when it allows them to be prescribed. Promoting a drug for any unapproved purpose is called off-label marketing. Off-label marketing is not necessarily illegal. However, Medicare and Medicaid do not pay for off-label usage and will not provide reimbursement for the cost of any drug prescribed for that purpose. If a drug is prescribed for an off-label reason but that fact is kept hidden, this can be a False Claims Act violation affecting the medical professional and, sometimes, the drug’s manufacturer.
A protected disclosure is a formal statement made by a whistleblower who reveals any of the following in their statement: fraud, corruption, false claims against government funds, or public safety hazards. The whistleblower is legally protected from certain retaliations or reprisals.
Qui tam is the shorthand notation for the legal provision enabling a citizen to bring a case alleging fraud or false claims on behalf of the government. It comes from a Latin phrase that, in its full form, translates roughly as “one who sues for himself as well for the king .”
A relator is simply the formal name used in legal proceedings for a whistleblower who sues for the government under the qui tam provisions of the False Claims Act. The term is used because a whistleblower “relates” the facts concerning the legal action.
Securities are financial instruments that carry monetary value. They include stocks, bonds, and certain other instruments such as derivatives.
Securities and Exchange Commission (SEC)
This law forbids a doctor from receiving any form of financial gain for referring a patient for tests or other medical services, and regulates Medicare and Medicaid patient referrals. Some exceptions to the law exist.
Unbundling is a way to obtain greater reimbursement from government healthcare programs by billing separately for each component of a medical procedure. Unbundling is fraud and is a basis for a whistleblowing case.
Upcoding is a way to obtain greater reimbursement from government healthcare programs by submitting billing codes that are incorrect, but result in a larger payment. Upcoding is fraud and is a basis for a whistleblowing case.
A whistleblower is a person who reports illegal activity and criminal actions they have witnessed. These illegal activities simply involve a company defrauding the government. Certain activities that involve a risk to public safety can also be a reason to blow the whistle.
The vast majority of whistleblowers are current or former employees of the companies or organizations who committed the fraud. However, whistleblowers can be anyone who has substantive information, including subcontractors, business competitors, customers, patients, other federal employees, and others.
Do you have knowledge of fraud against the government? We can help you with your next step.
If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.
For a free, confidential evaluation of your case, call the Louthian Law Firm today at 803-454-1200 or, if you prefer, you can fill out our online contact form.