Case Review Request

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If you would like to discuss a potential whistleblower matter with us, please fill out the  form below for a free and confidential case review.


Please provide your name, phone number, and email address so we may contact you after reviewing your entry. Your confidentiality is a top priority for us.

 

Name

 

Telephone number

 

email address (required)

 


Who is committing the fraud?

 

Please Describe the Fraud

 

What is your relationship with the entity committing the fraud?

 

What federal or state government funded program is the victim of the fraud

 

Do you have personal and non-public information regarding the fraud? YesNo

 

Do you have any evidence, documents, or witnesses to corroborate your allegations? YesNo

 

Please upload any documents you would like us to review

 

How large is the fraud?

 

What is the impact on public safety or patient care?

 

Is the conduct intentional fraud or negligence? IntentionalNegligenceOther

 

Did you have personal involvement in the fraud?YesNo

 

Does the entity committing fraud have sufficient assets and ability to repay the stolen money?YesNo

 

Do you believe the government already knows of this fraud? YesNo

 

Have you tried to report this information previously either internally or externally? YesNo

 

Have you faced retaliation for reporting this information, or are you concerned that you might if your employer learns of your whistleblowing? faced retaliationconcerned about retaliation

 


By providing you these materials and by reviewing the information you send, The Whistleblower Law Collaborative has not agreed to represent you nor have you agreed to the Whistleblower Law Collaborative. If we agree to accept a case, we will enter into a mutually agreeable written engagement agreement.

 

Filing and prosecuting a Whistleblower case takes a considerable investment of our time, money, and energy. Therefore, we only accept cases after conducting a thorough review. While we review your case, you are free to discuss a potential case with other counsel. Other law firms may view the merits and timeline of a case differently than we do.

 

If you have any questions, please feel free to contact us at any time about the status of our review of your potential case.

 

 

Remember to click the Send button above to submit your form. Thank you!


A member of our staff will contact you once your submission has been received and reviewed.

 

The Whistleblower Law Collaborative fully understands the very real and complicated concerns many people must address before pursuing a whistleblower claim.

 

Regardless of whether or not you choose to file a case, your confidentiality will remain protected.