What if the Government Decides Not to Pursue Your Whistleblower Case?

When a whistleblower files a qui tam lawsuit alleging fraud against the government, the Department of Justice (DOJ) must decide whether or not to intervene and participate in the case.

If the government decides to pursue the case…

The whistleblower and their lawyers work with the DOJ by sharing the information they discovered and cooperating as needed. Depending on the usefulness of the information and their level of involvement in the investigation, a whistleblower may be entitled to up to 25% of the government’s recovery.

Tip: An experienced whistleblower attorney knows how to fight for the greatest possible whistleblower reward in a successful case.

If the government decides not to pursue the case…

The whistleblower must decide whether or not to continue with the lawsuit without the government’s assistance. Under the False Claims Act, whistleblowers who continue with the lawsuit without qui tam government intervention can receive up to 30% of the recovery in successful cases.

So, how likely is it for a whistleblower to successfully pursue a case in which the government has chosen not to intervene? Well, I was recently involved in a case where this happened. Read on to learn how one South Carolina whistleblower alleged massive healthcare fraud by the St. Francis Health Care System, was turned down by the DOJ, and was awarded millions for his efforts in successfully continuing with his case anyway.^1,3

S.C. Whistleblower Accuses St. Francis Health System of Healthcare Fraud and Receives Millions for His Bravery^1,3

Sometimes, a system in place has gone unquestioned for so long that everyone assumes it is legitimate – but it actually may be unethical. That was the allegation over how the St. Francis Health System, made up of St. Francis Physicians Services, Inc., St. Francis Hospital, and Bon Secours St. Francis Health System, Inc. (collectively, “St. Francis”), compensated many orthopedic surgeons in Greenville, South Carolina.

For many years, St. Francis allegedly paid millions of dollars in kickbacks to Piedmont Orthopedic Associates (POA) surgeons, who generated “significant referrals” to the hospital system. But one brave individual questioned the system, and with the help of a dedicated whistleblower attorney team, he helped expose and stop alleged healthcare fraud against the government.³

Alleged healthcare fraud in South Carolina costs taxpayers millions

An orthopedic doctor came forward in 2018 and filed a qui tam lawsuit against St. Francis.

The lawsuit claimed that St. Francis “developed a strategy to lure the POA surgeons into becoming employees of the hospital system by paying them excessive compensation, including an annual bonus pool.” Specifically, the whistleblower accused St. Francis of offering to pay the doctors from a $3.95 million bonus pool annually when their practices incurred a net loss for the year.

This incentive allegedly resulted in false claims being submitted to Medicare and TRICARE as physicians referred radiology, labs, physical therapy, and other ancillary procedures to St. Francis.

The government declines to participate in the case against St. Francis

Despite the whistleblower’s information, the Department of Justice (DOJ) declined to pursue the case.

Fortunately, the whistleblower was backed by a committed team, including myself and former U.S. Attorney Bill Nettles, and we remained convinced that we had the evidence and facts to prove that healthcare fraud had taken place. We continued building the case, alleging that St. Francis had violated the False Claims Act, the Stark Act, and the Anti-Kickback Statute.³

The case culminates in a $36.5 million resolution and an end to the alleged kickbacks³

Bill and I continued to fight on behalf of our client.

During his historic tenure as U.S. Attorney, Bill’s office brought the District of South Carolina to top four in the country for whistleblower recoveries.¹ And I spent 20+ years prosecuting whistleblower cases on behalf of the federal government. We understood how to negotiate, what points of fact to push forward, and how to effectively interface with the government.

Our experience and diligence paid off.

In June of 2023, St. Francis agreed to resolve the case by paying $36.5 million to the government. This was the largest settlement ever for a false claims case initially declined by the DOJ in the history of South Carolina.³

The whistleblower’s life-changing reward for his efforts

The whistleblower who courageously filed the lawsuit in 2018 and provided the information of the alleged fraud is expected to receive approximately $10.2 million as a reward.^1,3

“We are grateful the relator brought these allegations forward. Relators are critical to identifying fraud and protecting the integrity of our Medicare System,” said U.S. Attorney Adair F. Boroughs for the District of South Carolina.

Get Clarity on Your Case From Carolina Whistleblower Attorneys

I understand that it takes an abundance of courage and conviction to come forward with your suspicions of fraud against the government. Unfortunately, healthcare fraud is one of the most common ways taxpayer’s funds are misappropriated, and whistleblowers like the one in this case are often the only ones with sufficient inside access to expose fraudsters.

Learn More: Dos and Don’ts of Blowing the Whistle

At Carolina Whistleblower Attorneys, our lawyers can help you determine if the behaviors and actions you have observed constitute government fraud. If it may be fraud, we know how to present your case to the government to pique their interest and try to get their participation. And if the government declines, we can help you decide on the next best step for you – including possibly pursuing the case without qui tam government intervention.

We can help you with your case by:

• Guiding you through the whistleblower process
• Trying to ensure you don’t suffer employer retaliation
• Putting you first every step of the way

We’ve represented dozens of qui tam whistleblowers, with tens of millions of dollars in total settlements since 2016.^1,4 If you suspect fraud, call us at 1-888-292-8852 or contact us online for a free and confidential case evaluation. The first person to blow the whistle is in the best position to get a potential award, so call today!

Frequently Asked Questions

Can I still get an award if the government decides not to pursue my whistleblower case?

Yes, you may still be eligible for a whistleblower award even if the government decides to not pursue your case if you and your attorney are able to successfully resolve your case under the False Claims Act.

How much of an award does a whistleblower get if the government intervenes in the case?

When the government decides to intervene, a whistleblower can receive up to 25% of the government’s recovery as an award in a successful case.

How much of an award does a whistleblower get if the government decides not to intervene in the case?

In a case in which the government decides not to intervene, a whistleblower who successfully resolves the lawsuit with a private attorney can receive up to 30% of the recovery as an award.

You May Also Be Interested In

What Is a Healthcare Kickback?

9 Common Examples of Healthcare Fraud

What Are the Potential Rewards of a Successful Whistleblower Lawsuit?