In 2003, two whistleblowers brought a qui tam suit against British pharmaceutical company GlaxoSmithKline (GSK) based upon evidence implicating the company in a massive fraud scheme against the United States government. With this proof, the federal government sued GSK in 2011. GSK ultimately pled guilty to charges of unlawfully promoting one prescription drug for unapproved uses; failing to report safety data for another drug; and falsely reporting drug prices for several other drugs. GSK settled with the government, agreeing to pay over $3 billion in fees—the largest settlement agreement in United States History. This fraud and hundreds more like it are being unearthed and prosecuted through the help of private citizens bringing qui tam claims.
The term qui tam is derived from the Latin phrase “who sues on behalf of the king as well as for himself.” In Medieval England, qui tam was a legal order that enabled citizens to sue individuals who defrauded the king. Today, qui tam is a provision of the False Claims Act. This provision allows private US citizens who possess evidence of fraud committed by persons or businesses against the federal government to bring suit against those wrongdoers on the government’s behalf.
Qui tam claims are especially important in exposing Medicare and Medicaid fraud. In 2011, the FBI estimated that between 3 and 10 percent of total health care expenditures were the result of fraudulent billings to health care programs. Since 1997, the Health Care Fraud and Abuse Control Program’s (HCFAC) fraud prevention efforts have returned over $25.9 billion to the Medicare Trust Funds and Treasury. Successful prosecution of defendants committing fraud depend in large part upon individuals who notice questionable and suspicious health care practices and bring them to the government’s attention through qui tam cases. Though health care fraud may take many forms, three of the most prevalent fraud schemes are (1) Fake Charges, (2) Unnecessary Treatments, and (3) Fake Health Care Providers.