Whistleblowers - Free Case Evaluation

Step 1: Tell Us About You

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

Phone Number - Optional

Alternate Phone - Optional

* Email Address

Step 2: Tell Us About the Company or Person Defrauding the Government

Name

Location

Are you a current or former employee of the company or person?

Current

Former

Never Employed There

What goods or services does this company or person provide the government?

What government agencies does this company or person deal with?

Step 3: Tell Us About the Fraud

What has the company or person done to defraud the government?

Which individuals were involved in the fraudulent conduct, and what did each of them do?

When did you learn of the fraud?

When did the fraudulent scheme start, and how long did it last?

Did you discuss your concerns with your employer or a supervisor?

Yes

No

Please provide details:

Did you discuss your concerns with anyone else?

Yes

No

Please provide details:

Has the fraudulent conduct been reported in the media or investigated by the federal or state government?

Yes

No

Please provide details:

Did you suffer any retaliation as a result of anything you did related to the fraudulent conduct?

Yes

No

Please provide details:

What is your best guess as to the dollar cost to the government of the fraud, and how do you estimate it?

Please provide details:

Do you have any other evidence of the fraud (e.g., documents, emails, recordings)?

Yes

No

Please provide details:

Have you ever filed a lawsuit against any person, company, or the government, and if so, what was the case about?

Yes

No

Please provide details:

Is there anything else you want us to consider in evaluating your case?

Yes

No

Please provide details:

Step 4: Submit Your Case for Evaluation

To have The Vernia Law Firm evaluate the case you have described above, please enter your name and today's date to acknowledge that you have read the conditions and agree to them.

First Name

Last Name

Date

* Indicates Response Required