Evaluating and Filing a Qui Tam Complaint: A Practical Checklist

Litigation > False Claims and Qui Tam | Published 26 July 2026 - Updated 19 August 2026 | UpLaw - uplaw.us

Qui tam cases are lost more often to procedure than to the merits. Work these in order.

Items marked ⚠ are the ones where the natural instinct causes the most damage.

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Section 1 — Viability screen

☐ Is federal money involved? No federal payment, no False Claims Act claim. ☐ Is the falsity objective and provable? ⭐ A provable factual falsehood beats a contested legal interpretation every time. ☐ Which liability provision applies under 31 U.S.C. § 3729 — presenting a false claim, using a false record, conspiracy, or a reverse false claim? ☐ Is there documentary proof? ⭐ A relator who can identify specific claims is categorically stronger than one describing a practice. ☐ What is the claim volume? Per-claim penalties make high-volume billing cases far more valuable than a single large contract dispute. ☐ Is materiality clear? Under Universal Health Services v. United States ex rel. Escobar, ask whether the requirement plainly drives payment and what the government actually does when it learns of noncompliance. ☐ Is scienter provable? After United States ex rel. Schutte v. SuperValu Inc. the inquiry is subjective — what did the defendant actually believe? ☐ Is the defendant solvent? ☐ Is the relator's knowledge independent and inside, rather than derived from public sources? ☐ Is the relator able to sustain three to six years of secrecy followed by public exposure? ☐ ⚠ The most common weakness is a relator certain something is wrong who cannot say which claims were false or why the requirement mattered to payment.

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Section 2 — Document handling

⭐ This is where relators most often damage their own cases, and the damage is frequently irreparable.

☐ ⚠ Do not take documents you are not entitled to have in the ordinary course of your job. ☐ ⚠ Do not take privileged material. ☐ ⚠ Do not take protected patient information beyond what is strictly necessary. ☐ ⚠ Do not download databases, mass-forward email, or copy shared drives. ☐ Describe rather than remove. ⭐ Identify which system holds the evidence, which report shows it, and who the custodian is — then let counsel and the government obtain it through a civil investigative demand under 31 U.S.C. § 3733. ☐ Write down what you know from memory, with dates and names, at home rather than on employer systems. ☐ Do not record conversations without confirming your state's law. ☐ Stop participating in the conduct, and document that you stopped. ☐ Preserve your own performance record — reviews, commendations, metrics — because a retaliation claim will turn partly on it. ☐ ⚠ Wholesale removal produces counterclaims, criminal exposure, sanctions, and dismissal. Courts have sanctioned relators for it.

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Section 3 — The bars, before filing

☐ Search for public disclosures — federal hearings, government reports, audits, inspector general findings, court filings, and news media. ⭐ The most common fatal disclosure is a government audit the relator never read. ☐ If a disclosure exists, assess original source status: voluntary disclosure to the government before filing, or knowledge independent of and materially adding to what was disclosed. ☐ Apply Graham County Soil & Water Conservation District v. United States ex rel. Wilson on which reports trigger the bar and Rockwell International Corp. v. United States on what the relator must know. ☐ Assess first-to-file risk. ⚠ You cannot know whether someone else has filed — everything is sealed. ⭐ This is the strongest argument for filing promptly rather than perfecting the complaint for another six months. ☐ Check limitations under 31 U.S.C. § 3731: six years from the violation, or three years after the responsible official knew or should have known, never more than ten. Cochise Consultancy v. United States ex rel. Hunt makes the longer period available to a relator even in a declined case. ☐ Confirm the defendant is a "person"; states are not, per Vermont Agency of Natural Resources v. United States ex rel. Stevens. ☐ Identify related state law claims that may be joined under 31 U.S.C. § 3732. ⭐ Where state Medicaid dollars are involved, the state claim can substantially increase the recovery.

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Section 4 — The disclosure statement

⭐ This document frames the case for the attorney who decides whether to intervene. It deserves more care than the complaint.

☐ Lead with what is provable, not with what is most outrageous. ☐ Distinguish knowledge from inference explicitly, in every paragraph. ☐ Identify the systems where evidence lives — which database, which report, which custodian. ☐ Name witnesses and state what each would confirm. ☐ Quantify claim volume and amount per claim, even approximately. ☐ Address the bars proactively — searches conducted, original source basis, and no known prior filer. ☐ Be candid about weaknesses. ⭐ A disclosure identifying the case's problems earns credibility that carries the whole matter; hiding them loses it permanently when the government finds them. ☐ Serve it on the government with the complaint, as 31 U.S.C. § 3730 requires.

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Section 5 — Filing

☐ File in camera and under seal. ⚠ Do not serve the defendant. ☐ Confirm venue under 31 U.S.C. § 3732. ☐ Plead with particularity under Federal Rule of Civil Procedure 9. ⚠ This dismisses more qui tam complaints than any substantive defense. ☐ Identify specific claims where possible; where not, plead a detailed scheme plus reliable indicia that claims were submitted. ☐ Plead the retaliation claim if applicable — it is your own claim, in your own name, and is not sealed. ☐ Anticipate motions under Federal Rule of Civil Procedure 12 and discovery under Federal Rule of Civil Procedure 26. ☐ Calendar the seal period — sixty days by statute, extended repeatedly in practice.

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Section 6 — Seal compliance

⚠ Seal violations can produce dismissal, and they are the most common self-inflicted wound in this practice.

☐ Tell no one. Not colleagues, not the press, not your union, not friends in the industry, not other counsel outside the case. ☐ Do not discuss it on employer systems, ever. ☐ Do not post about the underlying conduct on social media. ☐ Do not confront the wrongdoers or hint that something is coming. ☐ A spouse who understands the obligation may be told; anyone else is a risk. ☐ If the seal is inadvertently breached, tell counsel immediately — early disclosure to the court matters. ☐ ⭐ Expect long silences. Months of no news is normal and says nothing about the case's strength. ☐ Do not tell anyone, however long it lasts. The seal does not expire because you are tired of it.

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Section 7 — The government interview and investigation

⭐ The relator interview is the most important day in the case.

☐ Prepare thoroughly with counsel, including a walkthrough of the systems and the documents. ☐ Explain, do not argue. The government will decide the legal theory; the relator supplies the facts. ☐ Say clearly what you do not know. ⚠ A relator who oversells or cannot distinguish what they saw from what they inferred sinks the case in the first hour. ☐ Bring an organized chronology with dates, names, and document references. ☐ Answer follow-up requests promptly through counsel. ☐ Help with translation — explain the billing system, the coding conventions, the internal jargon, and who actually decides what. ☐ Identify the right custodians so civil investigative demands under 31 U.S.C. § 3733 reach the right material. ☐ Report new developments to counsel, not directly to the government. ☐ Expect a parallel criminal investigation you may never hear about. ☐ ⭐ Continued cooperation is what raises the relator's share within the statutory range under 31 U.S.C. § 3730.

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Section 8 — The intervention decision

☐ If the government intervenes: it takes primary responsibility; the relator remains a party with limited rights; settlement value typically rises substantially. ☐ If the government declines: the relator may proceed alone. ⚠ Not a merits judgment, but a hard and expensive road. Most declined cases do not succeed. ☐ Decide deliberately whether to proceed after declination, with a realistic budget and an assessment of the defendant's incentives. ☐ Partial intervention may occur as to some claims or defendants; clarify which. ☐ Government dismissal is available even after declination under United States ex rel. Polansky v. Executive Health Resources, evaluated under the ordinary voluntary dismissal standard. ☐ ⚠ Do not publicly litigate against the government's positions. It damages the relationship, the case, and the share. ☐ Settlement requires government consent where it intervened, plus court approval of the relator's share.

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Section 9 — Unsealing

☐ Plan for the day your name becomes public, months in advance. ☐ Employment: whether you will stay, whether you can, and what you will say. ☐ Finances: a multi-year horizon that may include job loss. ☐ References and future employment — the industry is smaller than you think, and some relators change fields. ☐ Family: who needs to know and when. ☐ Media: handle through counsel or decline entirely; decide in advance rather than in the moment. ☐ Security and harassment concerns, if the matter is high-profile. ☐ ⭐ Nothing about unsealing is a surprise except its timing. Everything about it can be prepared for.

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Section 10 — The retaliation claim

☐ Understand that it is independent. 31 U.S.C. § 3730 protects lawful acts in furtherance of an action or efforts to stop a violation — ⭐ whether or not a qui tam case is ever filed and whether or not it succeeds. ☐ Establish notice. Internal reports are usually how the employer's knowledge is proved; document every one. ☐ Log every change in treatment — assignments, schedules, reviews, exclusion from meetings — with dates and witnesses. ☐ Preserve favorable performance evidence before it disappears. ☐ Know the remedies: reinstatement with seniority, double back pay, interest, and special damages including litigation costs and fees. ☐ Note the three-year period. ☐ Check other statutes that may apply with different protected classes and procedures — securities awards and antiretaliation at 15 U.S.C. § 78u-6, tax awards at 26 U.S.C. § 7623, defense contractor protection at 10 U.S.C. § 2409, and federal employee routes at 5 U.S.C. § 2302, 5 U.S.C. § 1213, 5 U.S.C. § 1214, and 5 U.S.C. § 1221. ☐ ⚠ Internal reporting is not protected under every statute. Digital Realty Trust v. Somers limits securities antiretaliation protection to those who report to the Commission. ☐ See whistleblower and retaliation claims and reporting misconduct and preserving a retaliation claim.

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Section 11 — Share and resolution

☐ Know the ranges under 31 U.S.C. § 3730: fifteen to twenty-five percent where the government intervened, twenty-five to thirty percent where it declined. ☐ Document your contribution throughout — cooperation, translation, witness identification, and time spent. It determines where within the range you land. ☐ Understand the reductions: a diminished share where the relator planned and initiated the violation; ⚠ no share and dismissal upon conviction of related criminal conduct. ☐ Confirm fees and costs are sought from the defendant. ☐ Confirm the alternate remedy provision applies if the government proceeds administratively. ☐ Plan the tax treatment early. ⚠ The share is generally ordinary income, and the attorney's fee portion has its own treatment. See tax controversy for individuals. ☐ Confirm the release scope — what is released, by whom, and whether the retaliation claim is included. ☐ Address employment separation terms in the same negotiation where possible. See responding to a termination and reviewing a severance agreement.

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Section 12 — Health care theories, quickly checked

☐ Billing fraud — services not rendered, upcoding, unbundling, medically unnecessary services. ☐ Kickbacks — 42 U.S.C. § 1320a-7b. ⭐ A claim resulting from a violation is false by statute, which removes the hardest materiality argument. ☐ Self-referral — 42 U.S.C. § 1395nn, strict liability; regulations at 42 C.F.R. part 411. ☐ Retained overpayments — the reverse false claim theory plus 42 U.S.C. § 1320a-7k. ☐ Exclusion and penalties — 42 U.S.C. § 1320a-7 and 42 U.S.C. § 1320a-7a, with regulations at 42 C.F.R. part 1001 and 42 C.F.R. part 1003. ☐ Medicaid — 42 U.S.C. § 1396b. ☐ Criminal parallels — 18 U.S.C. § 1347, 18 U.S.C. § 1035. ☐ See medicaid and long-term care and medical billing and collections.

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Section 13 — Contracting theories, quickly checked

☐ Defective pricing, cost mischarging, product substitution. ☐ Specification failures while certifying compliance. ☐ Set-aside and eligibility misrepresentation. ☐ Contractor disclosure obligations — 48 C.F.R. part 3; responsibility and debarment at 48 C.F.R. part 9; administration at 48 C.F.R. part 42; clauses at 48 C.F.R. part 52. ☐ Criminal parallels — 18 U.S.C. § 287, 18 U.S.C. § 286, 18 U.S.C. § 1001, 18 U.S.C. § 1031, 18 U.S.C. § 1341, 18 U.S.C. § 1343; limitations at 18 U.S.C. § 3282. ☐ Administrative alternative — 31 U.S.C. § 3801, 31 U.S.C. § 3802, 31 U.S.C. § 3803. ☐ Other areas — grant fraud, customs and tariff evasion as reverse false claims, federally guaranteed lending, and disaster relief.

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Section 14 — If you are the defendant

☐ Preserve immediately on learning of an investigation. ⚠ Spoliation converts a defensible case into an indefensible one. ☐ Attack materiality first under Escobar; ⭐ evidence that the government paid with knowledge of the noncompliance is the most valuable fact available. ☐ Assemble contemporaneous evidence of good-faith interpretation — advice sought, guidance consulted, ambiguity documented. After SuperValu the scienter inquiry is subjective. ☐ Test the pleading under Federal Rule of Civil Procedure 9. ☐ Check every bar and the limitations period at 31 U.S.C. § 3731. ☐ Quantify penalty exposure early. ⚠ A defendant that has not calculated it is negotiating blind. ☐ Respond carefully to civil investigative demands under 31 U.S.C. § 3733. ☐ Assume a parallel criminal investigation may exist. ☐ Address collateral consequences — exclusion, suspension and debarment, and corporate integrity obligations that frequently cost more than the payment. ☐ Consider voluntary disclosure. ⚠ The window closes once a case is filed, and nobody knows a sealed case exists. ☐ ⚠ Do not retaliate. ⭐ A retaliation claim frequently survives a defense victory on the merits. ☐ See civil discovery and the criminal case from arrest to sentencing.

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Section 15 — Quick reference

Your situation	Do this first	Watch out for
Suspect fraud at work	Retain counsel before anything else	⚠ Do not remove documents
Considering filing	Run the viability screen	Federal money, provable falsity, volume
Preparing to file	Search public disclosures	Audits, not just news
Worried someone else filed	File promptly	⚠ First to file is an unobservable race
Drafting	Plead with particularity	Rule 9 dismissals
Filed and waiting	Say nothing to anyone	⚠ Seal violations
Government interview scheduled	Prepare with counsel; be candid about gaps	Overselling sinks cases
Government declined	Decide deliberately whether to proceed	Most declined cases fail
Case unsealing	Plan employment, finances, and family	The industry is small
Treated worse at work	Log everything; preserve reviews	Independent retaliation claim
Resolution approaching	Plan taxes and the release scope	Ordinary income; fee treatment
You are the defendant	Preserve; attack materiality	⚠ Do not retaliate

☐ Print this and work it in order. ⭐ The two decisions that determine most outcomes are made before filing: how documents are handled, and how honestly the case's weaknesses are described.

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Section 16 — Worked example: a case handled correctly

Priya is a compliance analyst at a diagnostic laboratory. Over four months she notices that the lab bills a panel of twelve tests whenever a physician orders any two of them, and that the ordering forms are designed to make the panel the default. She raises it twice internally. The second time, she is told the panel is "clinically appropriate" and to stop asking.

Week 1 — counsel. She retains counsel before doing anything else. Counsel walks her through the document rules on the first call: take nothing she is not entitled to have, describe where the evidence lives, and stop participating.

Week 2 — memory document. At home, she writes a twenty-page chronology from memory: dates, the meetings, the exact words used, the names of the people who designed the ordering form, and which system holds the claims data. She takes no files.

Week 3 — public disclosure search. Counsel searches inspector general reports, prior settlements, and industry press. There is a general audit report about panel billing across the industry. ⭐ This is exactly the kind of disclosure that kills cases. Counsel documents Priya's independent knowledge — the ordering form design, the internal instruction, the specific volumes — which materially adds to the general report and establishes original source status.

Week 5 — the disclosure statement. Forty pages. It leads with the ordering form and the claims volume. It states plainly what Priya does not know: whether senior management approved the design, and whether any physician complained. It identifies six witnesses and the two systems holding the data.

Week 6 — filing. Complaint filed in camera and under seal. Priya tells no one. She continues working, normally, and logs every change in how she is treated.

Month 4 — the interview. Three hours with a line attorney and two agents. Priya explains panel billing, walks through the ordering form, and says "I don't know" four times. ⭐ That is the answer that made the case credible.

Month 9 — Priya is terminated for "restructuring." She logs it, preserves her reviews, and counsel prepares the retaliation claim, which is not sealed.

Month 26 — intervention. The government intervenes after obtaining the claims data by civil investigative demand under 31 U.S.C. § 3733 and finding the ordering form in the defendant's own files.

Month 34 — resolution. Settlement, with Priya's share set toward the upper end of the intervened range under 31 U.S.C. § 3730 based on her documented contribution, plus resolution of the retaliation claim and her fees.

⭐ What made this work: counsel first, no documents removed, a candid disclosure that named its own weaknesses, prompt filing, absolute seal discipline, and a contemporaneous log of the retaliation. None of it required legal training — only knowing the rules before acting.

⚠ Compare the version where she forwards three months of claims exports to her personal email before calling anyone. Same facts, same misconduct — and now a counterclaim, a privilege problem, a possible criminal referral, and a case the government does not want to touch.

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Section 17 — Where to go next

☐ For the narrative overview and how these cases actually unfold, see suing on behalf of the government. ☐ For the complete framework — liability, procedure, bars, theories, damages, and defense — see the False Claims Act and qui tam litigation. ☐ For templates, worksheets, and letters, see the False Claims Act and relator toolkit. ☐ For whistleblower protection generally, see the employee who said something and the whistleblower protection and retaliation claim toolkit. ☐ If a professional license is implicated, see professional licensing and occupational discipline.

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Related Documents

• Suing on Behalf of the Government: How Qui Tam Cases Actually Work
• The False Claims Act and Qui Tam Litigation: A Comprehensive Guide to Relators, Seals, and Recovery
• The False Claims Act and Relator Toolkit