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Prosecution and prevention of health care fraud and abuse are essential to reducing U.S. health care spending.1,2,3 A number of recent high-profile cases have uncovered suspect business practices and led to substantial recoveries; in September 2009, for example, Pfizer paid $2.3 billion to settle allegations that it marketed its drugs illegally to physicians, leading to unnecessary payments by the government.4
Currently, 90% of health care fraud cases are "qui tam" actions in which whistle-blowers with direct knowledge of the alleged fraud initiate the litigation on behalf of the government.5 Qui tam derives from the Latin phrase qui tam pro domino rege quam pro se ipso in hac parte sequitur, meaning "who as well for the king as for himself sues in this matter." If a qui tam action leads to a financial recovery, the whistle-blower stands to collect a portion of the award. From 1996 through 2005, qui tam actions led to more than $9 billion in recoveries.6 Although such actions are touted as cost-effective7 and may deter inappropriate behavior,8 little is known about how well the qui tam process works.
From their vantage point at the center of the process, whistle-blowers have valuable insights. Popular portrayals of whistle-blowers vary widely: some anecdotes paint them as heroes struggling against corporate greed, emphasizing the hardships and retaliation they must endure; other accounts question their motives and the "excessive" rewards they receive.