Qui Tam Free Case Review

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Contact Information

First Name
Last Name
Home Phone - -
Work Phone - -
Cell Phone - -
Email
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Street Address
City
State
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Case Information

Profession
Name of Employer
Companies suspected to be involved
Company State
What actions/activity was fraudulent?
Who was involved in the fraud?
What are the individuals positions and what "role" did they play in the fraud?
Start date
Has the fraud ended?Yes No
Stop Date
Were you involved in the fraud?Yes No
If yes, please describe:
What documents do you have that can prove this fraud occurred?
Who will support your supposed fraud claim?
What evidence/documentation can they provide?
Have you talked with ANYONE about this fraud (this applies to loved ones, coworkers, employers, media, government officials, etc..)Yes No
If yes, please describe who you talked with and the details and outcome of the discussion.
If you talked with your employer about this supposed fraud, did your employer change any policies or attempt to retaliate against you?Yes No
If you lost your job, have you filed a lawsuit against your employer for wrongful termination?Yes No
Do you currently have a law firm or attorney representing you with this lawsuit?Yes No
How much money is potentially involved in this wrongdoing or fraud?
Do you believe that any people have been harmed as a result of this fraud?Yes No
Questions, comments, additional information

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