Qui tam case questionaire

<body bgcolor="#FFFFFF"> <div align="left"> <table width="500" border="0" cellpadding="0" cellspacing="0"> <tr> <td width="357" valign="top"><font SIZE="4" COLOR="#333366">Questionnaire</font> </td> <td align="right" valign="top"><img src="../../GIF/PC_url.GIF" width="143" height="14" align="right"></td> </tr> <tr> <td colspan="2"> <p>If you would like to have Phillips & Cohen LLP evaluate your potential case and consider representing you in a False Claims Act lawsuit: </p> <p>1) Carefully read this section.<br> 2) Print out the following preliminary information form.<br> 3) Fill it out.<br> 4) Sign the statement at the bottom.<br> 5) Send the signed statement and completed preliminary information form to us through fax, the U.S. mail or other delivery service.</p> <p>If you don't have a printer, please contact us and a staff member will mail or fax you a preliminary information form. You also may <big><strong><a href="https://whistleblowers.securesites.com/HTML/FRM/ScafmPrelim_f.htm" target="_top"><u>e-mail us</u></a></strong></big> the filled-out preliminary information form. The e-mail will be encrypted, but total security cannot be guaranteed.</p> <p>Once we have reviewed the preliminary information form, we will contact you and may request additional information. Phillips & Cohen carefully reviews potential cases to determine whether the False Claims Act applies, whether there is sufficient evidence of the fraud and how much money the government may have lost because of the fraud.</p> <p>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.</p> <p>When you are deciding whether to file a qui tam lawsuit, there are many factors to consider. Please refer to "<a href="pitfal_f.htm" target="_top">Pitfalls to Avoid</a>" for an explanation of some of these points.</p> <p>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. 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.</p> <p>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.<br> <br> 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 they may have more time and resources instantly available to investigate a potential case.</p> <p>If you would like Phillips & Cohen to evaluate your potential case and consider representing you, please print out this page, fill out the following form and mail it to us, or go to the e-mail version.</p> <p align="center"><b>PRELIMINARY INFORMATION</b></p> <p>Name ________________________________________________________</p> <p>Address_______________________________________________________</p> <p>City_____________________________________ State_____ Zip_________</p> <p>Tel. numbers: Home_____________________ Work____________________</p> <p>Fax number_____________________ E-mail address ___________________</p> <p>Profession/Job title ______________________________________________</p> <p>Employer _____________________________________________________</p> <p>Company/companies believed to be involved in the fraud __________________</p> <p>_____________________________________________________________</p> <p>Location of that company/companies (city, state) ________________________</p> <p>_____________________________________________________________</p> <p>If we need to contact you to obtain additional information, should we do so by</p> <p>e-mail or regular mail service? ______________________________________</p> <p><br> We appreciate having the opportunity to review your case. Please keep in mind that by providing you information about the False Claims Act and by reviewing the information you send, Phillips & Cohen LLP has <i>not</i> agreed to represent you nor have you agreed to retain Phillips & Cohen LLP.</p> <p>Given the above considerations, if you would like Phillips & Cohen LLP to review your potential case, please sign below and send us this entire form, including the filled-out preliminary information form.</p> <p>Signature ______________________________________________________</p> <p>Date _________________________________________________________</p> <p>Please send to:<br> Phillips & Cohen LLP<br> 2000 Mass. Ave., NW First floor<br> Washington, DC 20036<br> Fax: 202.833.1815</p> <p>Thank you. You may contact us at any time to inquire about the status of our review of your potential case.</p> <p></p> <p></p> <p align="center"> <font size="4"><b>Important notice</b></font></p> <p align="center"><b>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.</b><br> <br> <font size="1"><a href="AF_frm.htm" target="_top">About the firm</a> | <a href="fca_f.htm" target="_top">The False Claims Act</a> | <a href="wr_f.htm" target="_top">Whistleblower's reward</a> | <a href="caintr_f.htm" target="_top">Have a case?</a> <br> <a href="story_f.htm" target="_top">Whistleblowers' stories</a> | <a href="resman_f.htm" target="_top">Resources</a> | <a href="what_f.htm" target="_top">What's new</a><br> </font><br> <font size="1">© 2000 Phillips & Cohen. All rights reserved<br> <a HREF="cred_f.htm" TARGET="_top">Credits</a></font> </td> </tr> </table> </div><p> <a href="http://www.qui-tam-law-firm.com/index.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a><a href="http://www.qui-tam-law-firm.com/home.htm"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.qui-tam-law-firm.com/default.htm"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.qui-tam-law-firm.com/qui-tam-law.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.qui-tam-law-firm.com/sitemap.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.whistleblowers-fraud-laws.com/index.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.whistleblowers-fraud-laws.com/home.htm"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.whistleblowers-fraud-laws.com/default.htm"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.whistleblowers-fraud-laws.com/qui-tam-lawsuits.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> <a href="http://www.whistleblowers-fraud-laws.com/sitemap.html"><img alt="qui tam law firm" src="/Gif/dotclear.gif" width="1" height="1" border="0"></a> </p> </body>