Have a case

Questionnaire

If you would like to have Phillips & Cohen evaluate your potential case and consider representing you in a False Claims Act lawsuit:
1) Carefully read this section.
2) Print out the following questionnaire.
3) Fill it out.
4) Sign the statement at the bottom.
5) Send the signed statement and filled-out questionnaire to us through the U.S. mail or other delivery service.

Please fill out this form only after you have been instructed to do so by Phillips & Cohen. If you have not been instructed to do so, please go to the "Have a case?" page first.

If you don’t have a printer, please contact us and a staff member will mail or fax you a questionnaire. You also may e-mail us the filled-out questionnaire. The e-mail will be encrypted, but total security cannot be guaranteed.

We ask that you submit information about your potential case in writing so that we may properly assess the merits of your allegations and the strategic issues they raise. This will help us make an informed decision about whether Phillips & Cohen will be able to represent you. Please provide as much detail and supporting documentation as possible. If you would rather write a narrative, please address all the issues the questionnaire raises.

The statute of limitations for filing a False Claims Act lawsuit can be as short as six years and the opportunity for a private individual to bring a false claims action may be cut off if someone else publicizes the conduct at issue, files a False Claims Act lawsuit making similar charges or otherwise spurs the government into action before you file suit. If you know of any impending events that might pre-empt your claim, tell us immediately.

By law, your communications with us during the evaluation process are regarded as privileged and confidential and will be treated by us accordingly.

Name: ______________________________________________________

Address: ____________________________________________________

City:_______________________ State:_____________ Zip:___________

Telephone numbers: ________________ Home: Work: ________________

Which telephone number would you prefer that we call?________________

What times are best to reach you?_________________________________

Fax number:___________________ E-mail address:__________________

Profession/Job title: ___________________________________________

Employer: ___________________________________________________

Company believed to be involved in the fraud: __________________________________________

That company’s location (city, state):___________________________

The False Claims Act generally allows whistleblowers to bring qui tam lawsuits when the government has made payments based on false claims, paid claims based on false certifications or has not been paid money owed to it. The law does not apply every time the government makes an unwise purchasing or management decision. It also does not apply to cases of mistake or negligence.
1) With this in mind, describe how you believe that the company has violated the False Claims Act. Please include the following information:
a) What actions or activities do you believe were fraudulent?
b) Who was engaged in the fraud? What are their job titles or positions, and what role did those people play in the fraud?
c) When and how did you become aware of the fraud?
d) When did the fraud begin? Has it ended? If so, when?
e) What involvement, if any, did you have in the fraud?
f) What documents exist that would help prove the fraud? Do you have any of these documents? If so, please attach copies of key documents.
g) What witnesses would support your allegations? What evidence can they provide?
_______________________________________________________

_______________________________________________________

2) Have you discussed your allegations with anyone, including your employer, a local, state or federal government official or someone in the media? If so, please state with whom you discussed the matter, the circumstances and any response.

_______________________________________________________

3) If you discussed your allegations and concerns with your employer, was there any change in your employer’s practices after the conversation? Did anyone working for your employer threaten to retaliate against you, or was there any retaliation? If so, please describe.

4) If you lost your job, have you filed or are you considering filing a wrongful termination lawsuit? Please describe any action you have taken in this regard.

_______________________________________________________

5) Have your allegations been the subject of any legal or legislative action? For example, have they been disclosed in the course of a wrongful termination action, a products liability case, a congressional hearing or agency proceeding? If so, please describe.

_______________________________________________________

6) How much, in dollar terms, would you estimate the government has been damaged by the alleged wrongdoing? (In your calculations, exclude any penalties.) Describe how you arrived at your estimated damages.

______________________________________________________

_______________________________________________________

7) If the company involved in the fraud is not a large corporation, please describe what you believe to be the financial capability of the company to pay a large False Claims Act judgment.

_______________________________________________________

8) Have you ever filed a lawsuit against anyone or any company before?

_______________

What was the case about?

_______________________________________________________

We appreciate having the opportunity to review your case. Please keep in mind the following:

By providing you these materials and by reviewing the information you send, Phillips & Cohen has not agreed to represent you nor have you agreed to retain Phillips & Cohen.

Our review to determine whether your case is viable and our decision whether to accept it may take considerable time for several reasons. Before we commit ourselves to representing someone, we thoroughly analyze the applicability of the False Claims Act to the potential case. This process may include an investigation of the facts presented and sometimes consultations with experts in the field. Our firm has limited human, legal and financial resources available. While we review your potential case, we must continue to work on our existing cases and conduct reviews of other potential lawsuits. You should be aware that the vast majority of the cases we review are not accepted by the firm.

You may inquire about the status of our review of your potential case at any time.

A False Claims Act lawsuit can, and usually does, take a number of years from start to finish. The process of bringing a successful case is a major commitment by us in terms of personnel and other resources, which is why we conduct thorough analyses of potential cases before we accept them. The expense a law firm bears in bringing these lawsuits in both lawyer time and out-of-pocket costs is considerable.

Part of our analysis of your potential case will focus on practical considerations. Cases may be too small or too unsubstantiated (and therefore too risky) to justify the commitment of our firm’s resources.

If our time constraints do not fit your needs, you may wish to discuss your potential case with other counsel. Other law firms may approach the investigation of a potential False Claims Act case differently, such as filing a lawsuit at an earlier date with less substantiation than Phillips & Cohen requires, or may have more time and resources instantly available to investigate a potential case.

As you search for counsel, bear in mind that the statute of limitations can be as short as six years. In addition, any public disclosure of the fraudulent conduct, the filing of another False Claims Act lawsuit making the same charges or government action on the matter before your lawsuit is filed might be grounds for dismissal of a case. (Pitfalls to Avoid) Please be aware that our thorough and selective approach to case analysis may present added risks that one of these events might occur before we are in a position to decide whether to represent you and file a lawsuit on your behalf.

Given the above considerations, if you would like Phillips & Cohen to review your potential case, please sign below and send us this entire form, including the filled-out questionnaire.

Reminder: Please send this form only after you have been instructed to do so by Phillips & Cohen. If you have not been instructed to do so, please go to the "Have a case?" page first.

Signature_______________________________________

Date____________________________

Please send to:
Phillips & Cohen
2000 Mass. Ave., NW
First floor
Washington, DC 20036

Important notice

These pages should not be construed to contain legal advice. While we will treat any information provided as privileged and confidential, you should understand that when you provide information about a potential case to Phillips & Cohen, we do not become your attorneys. With your permission, we may use your information to investigate whether we wish to represent you to bring a case. But until we both sign a written agreement, we do not represent you and have not agreed to do so.