Qui Tam
We often find that people have heard of whistleblower cases but aren’t familiar with the legal term that makes many of these cases possible: qui tam. The phrase comes from the Latin expression qui tam pro domino rege quam pro se ipso in hac parte sequitur, which translates roughly to “he who sues in this matter for the king as well as for himself.” In modern U.S. law, this concept is most often tied to the False Claims Act and healthcare fraud.
When a whistleblower brings a case alleging fraud against the government, they file what is called a qui tam action. This means the whistleblower (also called the “relator”) brings the case not just for themselves but on behalf of the U.S. government. If the case succeeds, the government may recover funds lost due to fraud, and the relator may be entitled to a percentage of the recovery. This incentive structure has been one of the most powerful tools in uncovering large-scale fraud schemes, especially in healthcare billing and pharmaceutical practices.
Qui tam has roots in English common law, but in the United States, it gained its modern significance during the Civil War era with the passage of the False Claims Act in 1863. The government needed a way to combat rampant fraud among military suppliers, and this legal mechanism empowered citizens to act as watchdogs. Over the last several decades, qui tam provisions have led to billions of dollars in recovered funds tied to Medicare, Medicaid, and other healthcare programs.
The Latin term “qui tam” comes from the longer phrase “qui tam pro domino rege quam pro se ipso in hac parte sequitur,” which translates to:
“He who sues in this matter for the king as well as for himself.”
In modern terms, a qui tam refers to a law permitting a private citizen to bring a lawsuit on behalf of the government — and also share personally in any financial recovery. The phrase describes the unusual hybrid role of the whistleblower, who acts as both a private plaintiff and a representative of the state.
In today’s legal system, the term is most closely associated with the False Claims Act (FCA), which authorizes individuals to file lawsuits against entities that submit fraudulent claims for government funds — especially Medicare and Medicaid reimbursements in healthcare settings.
The unique feature of a qui tam action is that the lawsuit is initially filed under seal, allowing the government to investigate the allegations confidentially before deciding whether to intervene. This preserves evidence and protects whistleblowers during the early investigative phase.
The continuing relevance of this ancient Latin phrase reflects a powerful legal tradition: empowering individuals to enforce public laws when government resources alone cannot detect wrongdoing.
Qui tam actions are among the primary legal mechanisms linking whistleblowing to government fraud enforcement.
While whistleblowing broadly refers to reporting suspected wrongdoing, the qui tam provisions of The False Claims Act allows whistleblowers to file a civil lawsuit on behalf of the U.S. government. When healthcare employees uncover fraudulent billing, illegal kickbacks, off-label marketing schemes, or falsified cost reporting, this qui tam mechanism enables them to pursue legal action instead of relying solely on internal reporting channels or administrative complaints.
In a qui tam case, the whistleblower becomes known as the “relator.” They prepare and file a sealed complaint detailing what they know of alleged fraud and the supporting evidence. The U.S. Department of Justice then investigates and decides whether to intervene.
Unlike many other whistleblower reporting frameworks, the qui tam provisions of the False Claims Act make it so the government pays financial incentives to relators when their cases lead to successful enforcement. Specfically, relators may receive a percentage of the recovered funds, encouraging insiders to step forward when silent fraud drains taxpayer resources.
In healthcare, where billing fraud is often hidden in complex data systems, whistleblower-initiated qui tam suits have become the most effective detection tool — responsible for the majority of successful FCA recoveries each year.
Generally, any private individual with original, non-public information about fraud against the government can file a qui tam lawsuit.
This includes:
-Healthcare employees
-Former staff members
-Contractors and consultants
-Executives or compliance officers
-Medical professionals
-Billing specialists
-Patients and family members of patients
The key eligibility requirement is that the person must possess non-public, independent knowledge of the fraud.
Outside parties who learn about fraud through news articles, lawsuits, or internet research typically cannot qualify.
U.S. citizenship is not required. Whistleblowers can reside abroad so long as the fraud affects U.S. government spending.
Notably, an individual does not have to be personally harmed by the fraud to file — because the lawsuit is pursued on behalf of the United States, whose financial interests were injured by false claims.
The ability for almost any knowledgeable individual to initiate enforcement is what makes qui tam litigation such a powerful and decentralized fraud-detection system.
A qui tam lawsuit differs fundamentally from ordinary civil lawsuits because the whistleblower files the case, under seal, on behalf of the U.S. government rather than solely on their own behalf.
In a traditional lawsuit:
-A plaintiff sues to recover their own personal damages.
-The case proceeds publicly from the start.
-Settlement benefits only the plaintiff.
In contrast, a qui tam lawsuit:
-Seeks to recover money owed to the government, not the individual.
-Is filed under seal, remaining confidential for months or years.
-Allows the government to intervene and take over prosecution.
-Rewards the whistleblower with a percentage of the recovery instead of direct damages.
Another key difference is investigative involvement. In qui tam cases, the Department of Justice actively examines the evidence, interviews witnesses, and audits billing or procurement records before deciding whether to pursue the case.
In essence, qui tam lawsuits represent a partnership between private citizens and the federal government — blending civil enforcement with public accountability.
The concept of qui tam litigation originated in English common law during the Middle Ages, long before modern regulatory agencies existed.
Early monarchies lacked the resources needed to monitor commercial misconduct. To solve this problem, Parliament enacted statutes allowing citizens to prosecute violations on the Crown’s behalf. Rather than paying government inspectors, lawmakers incentivized enforcement by awarding bounties to those who successfully prosecuted offenders.
These early qui tam statutes targeted behaviors such as:
-Smuggling
-Counterfeiting
-Tax evasion
-Price manipulation
-Trade violations
The concept crossed into American law during the colonial period and stayed embedded in U.S. statutes after independence. The potential scope of qui tam litigation was expanded with the passage of the False Claims Act of 1863, created during the Civil War to combat defense contractor fraud.
Modern healthcare qui tam actions represent the contemporary evolution of this centuries-old enforcement model — empowering insiders to expose sophisticated fraud schemes where traditional oversight alone proves insufficient.
Whistleblowers — legally known as relators — are financially rewarded for successful qui tam cases under the False Claims Act.
The amount a relator receives depends largely on whether the government intervenes:
-15%–25% of recovered funds if the government has intervened.
-25%–30% if the government declines and the relator pursues the case independently to a successful resolution.
Relators may also recover reasonable attorneys’ fees and costs, which are paid separately by defendants and do not reduce the relator’s percentage award.
In healthcare cases involving massive Medicare or Medicaid recoveries, relator awards can reach millions — sometimes tens of millions — of dollars when fraud spans years or involves large providers or pharmaceutical companies.
These rewards reflect Congress’s recognition that whistleblowers bear substantial risk, including career disruption and emotional stress. By aligning personal incentive with public good, the FCA ensures that individuals with firsthand knowledge step forward when fraud remains hidden behind complex billing systems and institutional silence.
A qui tam lawsuit follows a unique confidential process distinct from ordinary civil litigation (at least in its early stages):
1. Investigation & Evidence Gathering – The whistleblower compiles documentation of fraud with legal counsel.
2. Sealed Filing – The complaint is filed under seal in federal court and served exclusively on the U.S. Department of Justice. The whistleblower also provides the government with a separate, and typically more detailed, “written disclosure” of evidence in the whistleblower’s possession. This written disclosure is not filed in court.
3. Government Investigation – DOJ, often working with OIG and sometimes FBI agents, investigates the allegations.
4. Intervention Decision – DOJ chooses to intervene (take over the case) or decline.
5. Case Unsealed – The lawsuit becomes public once government review concludes. If the DOJ has elected not to intervene, the whistleblower then has the right to continue litigating the action as a “declined case.”
6. Litigation or Settlement – The case proceeds through negotiations or trial.
7. Recovery & Relator Award – Financial settlements or judgments are paid, and the relator receives their statutory share.
This multi-stage approach allows confidential vetting and ensures serious cases are backed by full federal investigative power before public exposure.
