Review Your Potential Qui Tam Case

There are several important things to consider in reviewing your potential qui tam case. Please fill out this form to the best of your ability. It will be sent to Deskin Law Firm for review. You may also feel free to call Deskin Law Firm at (800)709-8978 to ask any questions or to review your matter over the phone.

No attorney client relationship is created by submitting this form until and unless a retainer agreement is signed, however, all information submitted will be kept confidential.

Your name: *

Please type your first and last name.

Your email address: *

Please type your email address and check it to make sure it is correct.

Your phone number: *

Please type your area code and phone number.

Your secondary phone number:

Please type a second phone number to reach you.

Name of the company that you are reporting fraud about: *

Name of your position: *

Please type the name of your job, like "Secretary," or "Vice President"

Your City and State: *

Please type the city and state (and country if outside the USA) that you live in.

Who made a false statement to the government for purposes of getting a claim paid: *

Please type the name of the person and his/her position who made a false statement to the government.

How do you know that this person made a false statement to the government: *

Please explain how you know that this person made the false statement. Were you there when the false statements were made or have you found out about it from others?

Who else, besides you, knows about the false claim: *

Was the false claim discussed in a room full of people or was it something you merely noticed or figured out?

What false claims were made: *

Please briefly describe each of the false claims that were made to the government.

What is the approximate dollar magnitude of the false claims: * $

Please estimate the dollar amount that the government has paid that it should not have paid to the best of your ability

Do you have documents to prove the false claims were made: *

Please list the documents you have and other documents that exist that you may not have.

Whistleblower's Guide to the False Claims Act

Qui Tam Guide

False Claims Acts

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